This is a legally binding Consent Form and Release of Liability made voluntarily by me, the undersigned Releasor, on my own behalf, and on the behalf of my heirs, executors, administrators, legal representatives and assigns to the [Organization] (hereinafter "The Organization")

The undersigned hereby acknowledges that participation in the above named activity involves inherent risk of physical injury and assumes all such risks. The undersigned hereby agrees that for the sole consideration of The Organization allowing the undersigned to participate in the above named activity for which or in connection with which the The Organization has made available any equipment, facilities, grounds or personnel for such programs or activities, the undersigned does hereby release and forever discharge The Organization, its members individually, and its officers, agents and employees of any and all claims, demands, rights and causes of action of whatever kind of nature, arising from and by reason of any and all known and unknown, foreseen and unforeseen bodily and personal injuries, damage to property, and the consequence thereof, resulting from participation in or in any way connected with the above named activity.

In an emergency, I acknowledge that I am solely responsible for all medical and other costs arising out of bodily injury or any loss sustained through participation in this activity. I authorize program staff to secure any licensed hospital, physician and/or medical personnel any treatment deemed necessary for the participant’s immediate care.

By the execution of this agreement, I accept and assume full responsibility for any and all injuries, damages, and losses of any type, which may occur to me, and I hereby fully and forever release and discharge The Organization, its officers, employees, and insurers including any self‐insurance funds of the The Organization from any and all claims, demands, damages, rights of action, present and future, whether the same be known or unknown, anticipated or unanticipated, resulting from or arising out of my participation in this camp.

Disciplinary action may be imposed whenever a Camp Attendee commits or attempts to commit any act of misconduct during the Camp, or at any activity, function, or event sponsored or supervised by The Organization, including but not limited to:

• Possession, use or distribution of an illegal or controlled substance, or look‐alike drug.

• Unauthorized and/or illegal possession, use or distribution of any alcoholic beverage.

• Theft of property or services.

• Intentional or willful and wanton destruction of property.

• Assault and/or battery.

• Possession of a weapon.

• Conduct which constitutes harassment or abuse that threatens the mental   well‐being, health or safety of any individual.

Consequences include, but are not limited to, time out, notifying parents, and removal from the program for the safety and well‐being of other campers.

Disciplinary action may also be imposed whenever a student commits any acts of misconduct during an off‐site event or activity.

Behavior Contract

We, the participant and the parent/guardian, understand and agree to abide by The Organization Code of Conduct.  I acknowledge that we are fully aware of the consequences resulting from the violation of any of the guidelines and agree to comply with the Code of Conduct. 

I authorize The Organization staff to administer immediate and emergency medical treatment,   including (1) transporting your child to a hospital emergency room or (2) calling the local rescue squad or ambulance. 

Name of emergency contact person(s) authorized to pick up participant (in case parent/guardian is unavailable)