3rd Annual EnviroCamp

Please sign my child up for the Enviro-Camp being held August 4 - 8 at Kirkmont Center.

I understand that the camp runs from 8:30 AM until 3:00 PM, and I agree to provide transportation. I further understand that Enviro-Campers must dress to be outdoors in the woods each day.

Campers may not have any electronic devices while at camp. Any needed communication will go through Kirkmont Center.

ASSUMPTION OF RISK AND RELEASE OF LIABILITY

I understand that my/my child’s participation in programs offered by Kirkmont Center is based on the “Challenge by Choice” philosophy. I recognize that the program is designed to use engaging teaching techniques, but that my participation is purely voluntary. At all times, I/my child will choose my level of participation in any activity. I understand that climbing, high ropes course, ground initiatives, and other activities in the program for which I/my child have enrolled entail certain risks. Those risks can include increased heart rate, blood pressure, strained or sprained muscles, fractured bones, partial or complete paralysis, heart attacks, psychological injury, death, or any possibility of other serious injuries. I elect to participate/have my child participate in spite of these risks. Therefore, for myself / my child, I knowingly and voluntarily assume all risks involved in my /his/her participation, and do hereby release Kirkmont Center and its members, trustees, officers, employees, independent contractors and agents from any and all liability, damages, costs, and expenses arising out of or relating to bodily or psychological injury, loss of life or personal property that may occur as a result of participating in this program, regardless of the cause. Should I/my child be injured during this training, I hereby authorize any medical care that is deemed in my best interest. I furthermore agree to follow Kirkmont Center safety and facilitation techniques as taught and illustrated during the facilitation training in which I am a participant. I understand that if I vary from these techniques that I may be liable in the event of injury, physical, emotional or otherwise. This portion of the agreement shall be in effect from this day forward. My child and/or I have read, understand and accept the terms and conditions stated herein and acknowledge that this agreement shall be effective and binding upon the parties during the entire period of participation in the said program. I have informed Kirkmont Center trainers in writing on the reverse of this form of any relevant medical conditions that could affect my participation in this program. I am signing this form of my own free will and I am not under duress to sign this form. 

PHOTO RELEASE

I understand the images, video, and film footage is often used by Kirkmont Center for promotional purposes. For my participation in activities to be conducted by Kirkmont Center, I hereby give my permission and consent, now and for all time, to Kirkmont Center and third parties collaborating with Kirkmont Center to make, reproduce, edit, broadcast or rebroadcast any video, film, footage, sound track recordings and photo reproductions of me and/or my narrative account of my experience at, for publication, display, or exhibition thereof in promotions, advertising, and legitmate business uses without any compensation to, and/or claim, by me. I may, or may not be, identified in such reproductions; however, I shall not be stated by name to have endorsed any particular commercial products or commercial services.