STATEMENT OF UNDERSTANDING Statement approval The following information is important for the safety and protection of your child(ren). Please read this information and sign below. • I understand that my child(ren)will not be released to any person(s) not listed on the enrollment form. • I understand that I am not to leave my child(ren) at camp site unless a staff member or volunteer is there to receive and supervise my child(ren). • I understand that it is my responsibility to sign in my child(ren) when he/she enters the camp site and sign my child(ren) out before he/she leaves the camp site. • I understand that my child(ren) will not be allowed to leave the camp with an unauthorized person. Any person authorized to pick up my child(ren) must be listed on this form. Authorization by telephone will not be accepted. • I understand that camp's staff and volunteers are not allowed to babysit or transport children at any time outside the camp site. ACKNOWLEDGEMENT AND ASSUMPTION OF RISKS Acknowledgement I expressly acknowledge that there are certain dangers, risks, illnesses and personal injuries inherent in participating in the’ camp, programs, events, classes, and/or other activities, which may result from unavoidable accidents or injuries. Physical activity, by its very nature, carries with it certain inherent risks that cannot be eliminated regardless of the care taken to avoid injuries. The camp’s programs can involve quick movements, and/or sustained physical activity, which places stress on the cardiovascular system. Specific risks vary from one activity to another, but the risks range from (1) minor injuries such as scratches, bruises, and sprains; (2) major injuries such as eye injury or loss of sight, joint or back injuries, heart attacks, and concussions; (3) catastrophic injuries including paralysis and death. I understand the risks that are inherent in activities made possible by the camp. I agree that the participation of my child(ren) is voluntary and I knowingly and freely assume all such risks, both known and unknown, even if arising from the negligence of the camp organization or others, and I assume full responsibility for the participation of my child(ren). I understand that the camp organization and its employees, agents, counselors, teachers, representatives, successors and assigns assume no responsibility for loss, damage, illness or injury to person or property that my minor child(ren) may sustain as a result of their physical condition or resulting from their participation in any camps, activities, programs, events, classes at and/or sponsored by such organization. I expressly acknowledge, on behalf my minor child(ren), heirs and executors, that I voluntarily assume the sole risk for any and all dangers, illnesses and personal injuries that may result from my minor child(ren)s’ participation in any camps /events /activities/programs/classes while at camp and/or sponsored by the camp. I also acknowledge that the camp may use photographs, videotapes, television programs, motion pictures, tape recordings, or other similar media for promotional purposes. I hereby consent to the use of my and/or my minor child(ren)’s name(s) and/or likeness(es) in such materials to be exhibited and used for advertising, trade purposes, solicitation of patronage, promotional purposes, or other similar purposes, even if my and/or my minor child(ren)’s’ name(s) and/or likeness(es) are an integral part of such photograph, videotape, television program, motion picture, tape recording, or other similar media. RELEASE Release In consideration of the camp organization allowing my minor child(ren) to attend and/or participate in any camps, programs, events, classes, or other activities at the camp location and/or sponsored by the camp organization, I hereby, for my minor child(ren), heirs, and executors, waive, release and forever discharge the camp organization and its employees, agents, counselors, teachers, representatives, successors and assigns, from and against any and all rights and claims for any loss, damage, illness or injuries to person or property sustained as a result of my minor child(ren) attendance and/or participation in any such camps, programs, events, classes, and other activities, whether or not such loss, damage or injury results from the negligence of the camp organization and its employees, agents, or representatives or from some other cause. I further waive any and all rights to inspect or approve the photograph, videotape, television program, motion picture, tape recording or other use of my and/or my minor child(ren)’s name(s) and/or likeness(es), including any written article, script, caption or other writing that may accompany such use of my and/or my minor child(ren)’s name(s) and/or likeness(es). I hereby, for my minor child(ren), heirs, and executors, waive, release and forever discharge the camp organization and its employees, agents, counselors, teachers, representatives, successors and assigns, from and against any and all liability, claims, losses, costs, expenses or damages for libel, slander, invasion of privacy, conversion, defamation, appropriation of likeness or any other claim based on the use of my minor child(ren)s’ name(s) and/or likeness(es) in any such materials. AGREEMENT TO PAY OWN MEDICAL EXPENSES Medical expenses I acknowledge, accept, and assume the risk of any and all medical conditions, limitations, or disabilities (whether temporary or permanent) that I or my child(ren) possess, whether known or unknown, which might contribute to or exacerbate any injury myr child(ren) might sustain as a result of participation in the summer camp's programs, activities, classes. I acknowledge and agree that if medical assistance (of any form, including emergency care, hospitalization, out-patient care, and/or physical therapy) is required or performed as a result of any injury my child(ren) sustain while participating in the summer camp’s programs, activities, classes, or observing, or using the summer camp's facilities, premises, or equipment, such medical assistance shall be at my own expense. I ACKNOWLEDGE THAT THE CAMP DO NOT CARRY ANY TYPE OF ACCIDENT OR HEALTH INSURANCE ON THE PARTICIPANTS IN ITS ACTIVITIES. I ALSO ACKNOWLEDGE THAT INJURIES CAN BE CATASTROPHIC FOR THOSE WITHOUT PROPER MEDICAL COVERAGE. ARBITRATION OF DISPUTES - TIME LIMIT TO BRING CLAIM Arbitration I understand that by agreeing to arbitrate any dispute as set forth in this section, I am waiving my right, and the right(s) of my \child(ren) to maintain a lawsuit against: - the camp and - its owners, directors, officers, employees, affiliates, volunteers, participants, contractors and agents, as well as their successors, predecessors-in-interest, and insurers (collectively referred to as “camp’s Releasees”) for any and all claims covered by this Agreement. By agreeing to arbitrate, I understand that I will NOT have the right to have such claim determined by a jury, and my minor child(ren) will NOT have the right to have claim(s) determined by a jury. Reciprocally,the camp and the camp’s Releasees waive their right to maintain a lawsuit against me and the child(ren) below for any and all claims covered by this Agreement, and they will not have the right to have their claim(s) determined by a jury. ANY DISPUTE, CLAIM OR CONTROVERSY ARISING OUT OF OR RELATING TO MY CHILDREN PARTICIPATION IN THE CAMP - INCLUDING THE DETERMINATION OF THE SCOPE OR APPLICABILITY OF THIS AGREEMENT TO ARBITRATE, SHALL BE BROUGHT WITHIN ONE YEAR OF ITS ACCRUAL (i.e., the date of the alleged injury) AND BE DETERMINED BY ARBITRATION IN WASHINGTON DC BEFORE ONE ARBITRATOR. THE ARBITRATION SHALL BE ADMINISTERED BY JAMS PURSUANT TO ITS RULE 16.1 EXPEDITED ARBITRATION RULES AND PROCEDURES. JUDGMENT ON THE AWARD MAY BE ENTERED IN ANY COURT HAVING JURISDICTION. THIS CLAUSE SHALL NOT PRECLUDE PARTIES FROM SEEKING PROVISIONAL REMEDIES IN AID OF ARBITRATION FROM A COURT OF APPROPRIATE JURISDICTION. This Agreement shall be governed by, construed and interpreted in accordance with the laws of the State of Maryland, without regard to choice of law principles. Notwithstanding the provision with respect to the applicable substantive law, any arbitration conducted pursuant to the terms of this Agreement shall be governed by the Federal Arbitration Act (9 U.S.C., Sec. 1-16). I understand and acknowledge that the JAMS Arbitration Rules to which I agree are available online for my review at jamsadr.com, and include JAMS Comprehensive Arbitration Rules & Procedures; Rule 16.1 Expedited Procedures; and, Policy On Consumer Minimum Standards Of Procedural Fairness. INDEMNIFICATION Indemnification I hereby represent and warrant that I have the authority to execute this Participant Waiver Form on behalf of my minor child(ren) as parent, guardian and/or next friend, if applicable. In the event of any misrepresentation or breach of the foregoing warranty by me or my minor child(ren), heirs, and executors, or in the event that I, my minor child(ren) or any other person nevertheless asserts any claim against the camp organization arising out of my minor child(ren)’s participation in any camp, program, event, class or other activity as set forth herein, I agree to indemnify, hold harmless and defend the camp organization from and against any and all liability, claims, losses, costs, expenses or damages resulting therefrom, including, but not limited to, claims of loss, damage, illness or injury to person or property whether or not such loss, damage, illness or injury results from the negligence of the camp organization or from some other cause. TERM Term I understand that this agreement extends forever into the future and will have full force and legal effect each and every time my child(ren) listed below participate in the summer camp’ s programs, activities, classes, or observe, or use the summer camp's facilities, premises, or equipment. ACKNOWLEDGMENT OF UNDERSTANDING Acknowledgment of Understanding I certify that I am at least eighteen (18) years of age, and that I have read, and I understand this STATEMENT OF UNDERSTANDING, WAIVER FORM AND ACKNOWLEDGEMENT as indicated by my signature below. I acknowledge that I am signing freely and voluntarily, and intend by my signature to provide a complete and unconditional release of all liability for myself, my minor child(en) and the other participants whose names are listed below. IN SUMMARY, BY MY SIGNATURE BELOW, I ACKNOWLEDGE THAT IF I OR ANY OF MY MINOR CHILDREN OR THE OTHER PARTICIPANTS WHOSE NAMES ARE LISTED BELOW ARE INJURED IN ANY WAY, THIS WAIVER PREVENTS AND PROHIBITS ANY RECOVERY OF MONEY FROM ANY CAMP RELATED ENTITY OR CAMP’ RELEASEES. If I do not agree to any of these terms, I understand I do not need to sign it, and I may forego the Participation of my minor child(ren) in the programs and activities of the camp as the alternative. ACCEPTANCE Name of campers * Please list first and last name(s) of camper(s) that you enrolled in the camp, separated by commas. List of Authorized Persons * Please list first and last name(s) of persons authorized to pick-up the camper(s) that you enrolled in the camp, separated by commas. Acceptance * I expressly acknowledge and agree to the terms and conditions set forth on this Form. Signature Please type your name here as signature of the form above: * Form should be completed by parent or legal guardian.
