Ymca Summer Day Camp Form - 2016 (Page 8 of 9) in pdf

MEDICATION PERMISSION AND

Parent/Guardian Permission

(check all that apply)

□ My child has permission to swim during camp.

COMPETENCY

□ My child has permission to swim in the deep end.

Swimming ability: Non-Swimmer □

Fair □

Good □

I _________________________________________________________ have

Child must pass a deepwater test prior to being

allowed to swim in the deep end each day.

determined that the YMCA staff is competent to give or apply

□ I give my child permission to participate in field trips

medication to my child(ren). I understand that YMCA has the

during camp. Field Trips will include both walking and

responsibility to assess the ability of staff to give or apply

bus transportation.

medication safely and may give or apply medications to my

□ I give to the YMCA, its nominees, agents and assigns,

unlimited permission to use and publish testimonials,

child.

photos, videos, etc. for purposes of advertising and/or

education.

Parent Signature:

Signature

__________________________________________________________________

______________________________________________________________________

Date: ___________________________________________________________

Friend Request

Name: ___________________________________________________________

TRAIL RELEASE

By signing my name at the bottom of this Release, for and in consideration of the opportunity to ride a horse provided by this state

park, I agree to pay for this ride and further agree as follows:

1) That I know and understand that this horse riding activity is a walking ride only (no galloping) and involves specific risks of

property damage or personal injury or death to me or to my minor child arising from approaching, handling, mounting, rid-

ing, and dismounting the horse and from observing or participating in this activity; that I know and understand that a horse,

irrespective of its training and usual past behavior and characteristics, may act or react unpredictably at times based upon

instinct or fight which is likewise, is an inherent risk assumed by a horseback rider.

2) That I hereby release and forever discharge the State of Nebraska, its agents, and employees all present and future claims

arising from personal injury or property damage sustained by me or by my minor children during the use of the horse, and I

shall assume all risk related to horseback riding.

3) That I waive my right to file and promise not to file any legal proceedings against the State of Nebraska, its agents, or

employees for any personal injury or property damage sustained by me or my minor children during this activity; and I shall

pay all costs and attorney’s fee from any legal proceeding which I may bring contrary to this agreement and which is

resolved in favor of the State of Nebraska, its agents, or employees.

4) That I sign this Release Agreement for and in consideration of the agreed price, and I hereby request the State of Nebraska,

its agents or employees to chose for me and my minor children a horse for the purpose of riding, same knowing that the

Sate of Nebraska, its agents, or employees are relying upon this Release Agreement and the information that I have given to

them concerning my experience and that of my minor children with horses, including the potential hazards involved.

5) That I have read the foregoing release and sign it freely with full knowledge of its meaning and content.

6) No double riding.

7) No one under the age of 8 years old may ride.

8) No refunds for any reasons.

Parent/Guardian Signature:______________________________________________________________________________________ Date: ___________________

YMCA OF GREATER OMAHA . . Page 8

Ymca Summer Day Camp Form - 2016 Page 8

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