Visitor Release (camp NOT in session), Medical Reporting, and Hold Harmless Agreement
The Painted Turtle Camp and its employees, directors, volunteers and affiliates (“The Camp”) are pleased to have you as a guest and welcome you to visit and enjoy our beautiful camp and its facilities (“the Campgrounds”).  We take great pride in the campgrounds and do our best to ensure a safe environment for our campers, staff, volunteers and guests.  However, we cannot prevent all accidents or encounters with nature that may occur.  Indeed, the campgrounds are located in a rural environment that has a small lake and is teeming with wildlife such as snakes, spiders, coyotes, etc.  Additionally, we stable horses on the campgrounds, and there are many man-made structures that could result in a trip or fall or other injury.  In order to provide our friends and guests access to the campgrounds, no liability whatsoever can be accepted by The Camp, or any of the organizations or persons connected with The Camp.  Further, it should be understood that although we have a limited medical facility on the campgrounds, it is set up for the treatment of our young campers, and not for our visitors.  As such, we generally will not provide medical treatment to our visitors.  Accordingly, no visitor will be allowed to visit the campgrounds until this form has been read, understood, and completed by the visitor (if he/she is 18 years or older) or by the parents(s) or guardian(s) of a minor. Although The Camp and its staff make every reasonable effort to avoid injury or accident, the undersigned acknowledge and accepts the inherent risks involved in, among other risks, visiting a rural area and being exposed to high temperatures and various wildlife; walking on uneven terrain; being around horses kept at the campgrounds; and, potentially slipping and falling on man-made structures.

In consideration of the privilege of being allowed to visit the campgrounds, the undersigned, as self, or as parent(s) or guardian(s) of the undersigned minor, hereby agrees to release, defend, indemnify and hold The Camp, its officers, directors, trustees, agents, employees, representatives, successors, and assigns harmless from all manner of liability, loss, cost, claims, demands, and damages of every kind and nature whatsoever, including but not limited to reasonable attorneys’ fees, the undersigned or said minor may now or in the future have against The Camp, its officers, directors, trustees, agents, employees, representatives, successors, and assigns, on account of any accident, damage, injury, or illness, physical or mental condition, known or unknown, to the undersigned or said minor, or the treatment thereof arising as a result of, or in any way connected to acts or incidents occurring at or related to the campgrounds or The Camp, its officers, directors, trustees, agents, employees, representatives, successors, and assigns, including but not limited to their negligence or gross negligence in operation of the campgrounds.  This release and hold harmless shall not apply to intentional or willful conduct by The Camp.

I understand that as a condition of visiting The Painted Turtle, I give The Painted Turtle my permission and approval to use my image, name, biographical information, and/or audio recording as part of its fundraising efforts, advertising, publicity, promotion, or any other use.  I understand and agree that photographs, video footage, and statements of me may appear in any media format now known or hereafter invented including, but not limited to, print materials ( e.g. brochures, letters, posters, camp albums)videos, emails, online presentations, and/or social media without compensation.  I hereby grant permission to The Painted Turtle to share my image, name, biographical information, and/or audio recording with their respective affiliates including, but not limited to, SeriousFun Children’s Network, Inc., health partners, corporate partners, and authorized news media.  I hereby waive any right to inspect and approve the uses to which it may be applied.  Nothing herein will constitute any obligation of The Painted Turtle to use any of the above rights.

Please read and complete before your camp visit.
Sign in to Google to save your progress. Learn more
Date of Camp visit: *
MM
/
DD
/
YYYY
Who is Your Staff Host? *
Visitor's Name: *
Visitor's Birthdate: *
MM
/
DD
/
YYYY
Preferred Mailing Address: *
E-mail Address: *
Phone: *
I do not wish to be added to The Painted Turtle mailing/email list?
Parent or Guardian Name:
Relationship to Child:
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy