Creative Summer Camps with Karlyn!
Sketchbooking and Beyond
Session 1: August 15-19, 2022   
Session 2: August 22-26, 2022  
12:30 - 3:00 pm 

All camps will take place outdoors at the Larry Spring Museum of Common Sense Physics, 225 E. Redwood Ave. Fort Bragg, CA. 

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Child Name *
Child Date of Birth *
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Which Camp(s) are you registering for today? *
AS THE PARENT OR AUTHORIZED GUARDIAN OR REPRESENTATIVE, I HEREBY GIVE CONSENT TO Karlyn DeSteno and Creative Summer Camps TO OBTAIN ALL EMERGENCY MEDICAL OR DENTAL CARE PRESCRIBED BY A DULY LICENSED PHYSICIAN (M.D.) OSTEOPATH (D.O.) OR DENTIST *
INSURANCE NAME *
POLICY #: *
PHYSICIAN NAME, LOCATION, AND PHONE NUMBER *
Please list any medical conditions, including allergies, or medication your child may be taking or may require. *
PARENT/GUARDIAN NAME: *
PARENT/GUARDIAN PHONE: *
PARENT/GUARDIAN EMAIL: *
PARENT/GUARDIAN 2 NAME:
PARENT/GUARDIAN 2 PHONE:
PARENT/GUARDIAN 2 EMAIL:
CARE MAY BE GIVEN UNDER WHATEVER CONDITIONS ARE NECESSARY TO PRESERVE THE LIFE, LIMB OR WELL BEING OF THE CHILD NAMED ABOVE. *
EMERGENCY CONTACT 1 (NAME, RELATION, PHONE) *
EMERGENCY CONTACT 2 (NAME, RELATION, PHONE) *
EMERGENCY CONTACT 3  (NAME, RELATION, PHONE) *
COVID-19: All camps will be held outdoors. Masking will be optional. We may occasionally spend time in a semi-enclosed outdoor space, such as a 3-walled tent. *
I agree to monitor my child for symptoms of Covid-19 and to notify the camp director immediately of any Covid-19 exposure that may have impacted other campers. *
Agreement
Agreement
IN CONSIDERATION of being permitted to participate in any activities at Creative Summer Camps for any purpose, including, but not limited to observation, use of equipment, or participation in any other way (hereafter, “Camp Activities”), I/We, the Parent(s) or Guardian(s) of the above-named child(ren) (“Child(ren)”) agree to the following:

1. RISKS. I/We HEREBY ASSUME FULL RESPONSIBILITY FOR AND RISK OF BODILY INJURY, DEATH OR PROPERTY DAMAGE for any reason, including the negligence of Karlyn DeSteno in Creative Summer Camps (hereinafter, “CSC”), its directors, officers, employees, agents, and volunteers (collectively, “Releasees”) or otherwise while participating in CSC Activities.
I/We understand there are inherent and other risks of injury and illness involved in camp activities including but not limited to risks of Covid-19 and other communicable diseases, falls, collisions, and inherent risks associated with walking in the downtown Fort Bragg area.
I/We understand that risks of injury are impossible to eliminate fully by even the most careful and prudent planning and conduct. I/We give permission for the Child(ren) to participate in all CSC Activities. I/We, acknowledge and understand that participation in CSC Activities is completely voluntary, and the Child(ren) and I/We expressly agree to assume any and all liability associated with participation in CSC Activities.

2. MEDICAL AUTHORIZATION AND MEDICAL INSURANCE. I/We authorize CSC, at the discretion of any member of management, to obtain medical care for the Child(ren) and/or transport or arrange to transport the Child(ren) to an appropriate medical facility if emergency medical attention appears to be necessary. I/We further authorize a medical care provider to carry out any emergency medical care of the Child(ren). I/We agree to pay all costs associated with such medical treatment and related transportation for the Child(ren). I/We agree the Child(ren) has health insurance to pay any potential medical bills incurred for personal injuries at ECC and waive any right of subrogation against CSC. To the fullest extent allowed by law, I agree to pay without right of subrogation, all uninsured medical expenses incurred by the Child(ren) as a result of their participation in CSC even if the expenses result from the alleged negligence of CSC.
 
3. RELEASE, INDEMNIFY AND AGREEMENT TO HOLD HARMLESS
To the fullest extent allowed by law, I/WE AGREE TO COMPLETELY RELEASE, WAIVE, AND DISCHARGE, FROM ALL LIABILITY, arising out of or in connection with any CSC Activity whether caused by the negligence of the Releasees or otherwise, or all liabilities associated with any and all claims related to any CSC Activity that may be filed on behalf of or for the Child(ren). I/WE AGREE TO INDEMNIFY AND SAVE AND HOLD HARMLESS the Releasees and each of them from any loss, liability, claim, cause of action, damage, cost, lawsuit, or judgment of any and every kind that I/We, my/our heirs, executors, administrators or assignees may have against CSC, or that any other persons or entity may have against CSC because of any death, personal injury or illness, or because of any loss or damage to property that occurs during CSC Activities and that results from any cause, including negligence of the Releasees. I/We understand that I/We are waiving our right to take legal action including filing a lawsuit for personal injuries to our Child(ren) and/or ourselves.

4. RESPONSIBILITY. I/We shall have the sole responsibility to educate myself/ourselves and the Child(ren) concerning the risks of injury or loss of life and the benefits involved in the activity as described above. I/We shall reiterate all rules and instructions to the Child(ren). I/We shall make all decisions concerning the Child(ren)’s participation in the activity and shall enforce all rules and instructions. I/We represent and warrant that the Child(ren) is physically, mentally and emotionally able to participate in all of the activities and follow the rules and instructions. I /We agree to be fully responsible and to pay for any damage or loss to any equipment used by the Child(ren).

5. This agreement is severable and if a court determines any part to be invalid, then all other parts shall remain in effect. This agreement shall be interpreted and governed by California law. The venue of any dispute that may arise out of this agreement or otherwise between the parties to which ECC or its agents is a party shall be California State Court in San Francisco County. I/We HAVE CAREFULLY READ, CLEARLY UNDERSTAND AND VOLUNTARILY SIGN THIS AUTHORIZATION AND INDEMNIFICATION AGREEMENT AND RELEASE FROM LIABILITY. IF THE CHILD’S AGE IS MISREPRESENTED, THEN EARLY CHILDHOOD CAMP IS RELEASED FROM PROVIDING THE REQUESTED RECREATIONAL ACTIVITIES WITHOUT ANY REFUND.

I AGREE WITH THESE TERMS. *
A $50 deposit is required to hold your child's place and complete registration. The balance is due any time before the first day of camp. How to pay: Venmo: @Karlyn-DeSteno /  PayPal: karlyn.desteno@gmail.com / Please let me know if you prefer to pay by check. *
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