PARENT OR GUARDIAN STATEMENT:

I have read the description of Camp Rosenbaum and its activities, including equine assisted activities (the "Activities"), and understand the scope and potential demands of the Activities. To the best of my knowledge, I believe that the child identified above (the "Child") is physically and mentally able to participate in the Activities. Child is not suffering from, nor has Child been exposed to, any condition that might be harmful to other children or camp staff.

WAIVER AND RELEASE: I acknowledge that Child's attendance at Camp Rosenbaum, and Child's participation in the Activities, involves acceptance of certain inherent risks, including physical injuries, accidents, illness, or death. For myself and Child, I assume all risks of Child's attendance at Camp Rosenbaum and Child's participation in the Activities.

In consideration of allowing Child to attend Camp Rosenbaum, and to participate in the Activities, I, as parent or legal guardian of Child, on behalf of Child, myself, and our respective heirs, personal representatives, and assigns, hereby release Camp Rosenbaum Fund, its affiliated companies, and any of their shareholders, members, directors, officers, managers, employees, agents and volunteers (collectively "Released Parties") from any and all claims resulting in personal injuries, accidents, illnesses, death, property loss, or other losses (collectively "Claims") arising out of or in connection with Child's attendance at Camp Rosenbaum or participation in the Activities, including equine assisted activities.

I, as parent or legal guardian of Child, on behalf of Child, myself, and our respective heirs, personal representatives, and assigns, waive any Claims that might otherwise exist arising out of or in connection with Child's attendance at Camp Rosenbaum or participation in the Activities, including equine assisted activities.

The release and waiver granted by this paragraph includes, but is not limited to, claims resulting from the negligence of the Released Parties.

MEDICATIONS AND EMERGENCY MEDICAL TREATMENT: I authorize Camp Rosenbaum's staff to administer the above-listed medication(s) to Child while Child is attending Camp Rosenbaum. I agree to supply Camp Rosenbaum with sufficient medication for Child for the entire week of camp. I, as parent or legal guardian of Child, give permission for Child to receive emergency medical or surgical treatment and/or hospitalization if necessary.

PUBLICITY: On behalf of Child and myself, I give my permission and consent to Camp Rosenbaum Fund to allow, without compensation to Child or me, photographs and video to be taken of Child during the week of camp. I agree that any such photographs or video may be published or used in any and all print, electronic, or social media platforms of any kind and nature for the purpose of raising awareness in the community about Camp Rosenbaum and its activities, mission and purpose. Such use may include memorabilia (such as a slideshow or photos for campers), publications (such as brochures, annual reports, newsletters, or the Camp Rosenbaum web site), media and promotions (such as editorials, newspaper articles, social media, or television) and presentations to sponsors (for the sole purpose of promoting their support of Camp Rosenbaum).

All information given on this application is correct to the best of my knowledge. I completely understand all of the above.