Ymca Of Montclair - Camp Registration Form

PARTICIPATION & PERMISSION AGREEMENT

PLEASE INITIAL EACH STATEMENT

I hereby enroll my child,

in the YMCA of Montclair Summer Camp. I

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certify that s/he is healthy and free of problems that could adversely affect his/her stay or that of other campers at the

YMCA of Montclair Summer Camp.

I grant permission for my child to participate in all scheduled camp activities, including bus transportation

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(if applicable), swimming, and field trips (if applicable), unless otherwise stated in writing to the YMCA of

Montclair.

I understand I must complete and submit medical forms on CampInTouch/CampMinder required by law

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prior to the start of camp. When completing the medical forms, I will list any conditions that might affect

my child’s performance at camp, or any conditions of which the staff should be aware (medical treatment,

allergies, asthma, special requirements).

I hereby give permission for images of my child, captured during YMCA of Montclair events through

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video, photographic, digital, electronic, or any other media together, with or without his or her name and

hometown, to be used in YMCA of Montclair and YMCA of the USA promotional material and publications

(including release to the news media), and waive any rights of compensation or ownership thereto.

I hereby release and hold harmless the YMCA of Montclair, the YMCA of the USA, their agents and

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representatives, and any third parties involved in the creation or publication of the promotional materials

from any liability or claims by me or any third party for violations of my personal, proprietary or privacy

rights or those of my child in connection with the use of such images.

I grant the YMCA of Montclair and its agents full authority to take whatever actions they deem necessary

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regarding my child’s health and safety, and I fully release the YMCA of Montclair from any liability in

connection there within. In the event of an emergency, I understand that prudent attempts will be made

to contact the undersigned immediately. I understand the camp fees do not include health and accident

insurance and I will be responsible for any and all charges incurred for prompt medical treatment.

I understand that my child must comply with the camp’s rules and standards of conduct and that the YMCA

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of Montclair may terminate my child’s participation in the camp program if s/he does not maintain these

standards. If a camper is dismissed for inappropriate behavior, camp fees are non-refundable.

I will read the camp policies and procedures as explained in the applicable parent information packet

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(available at ).

I indemnify and hold harmless the YMCA of Montclair and its employees from liability for any harm that

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befalls my child as a result of participation in the YMCA of Montclair Summer Camp.

I give permission for YMCA of Montclair staff to apply or reapply as necessary sun lotion/bug spray that I

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provide for my child.

Reservation not valid without a signature and will be returned.

By signing below, I acknowledge and accept the above stated release and the YMCA of Montclair’s camp policies that I

have initialed.

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__________________________________________________________________

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Printed Name

Parent/Guardian Signature

Date

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Ymca Of Montclair - Camp Registration Form - 2017 Page 2

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