Mid-Winter Mini Camp

1. The Kings Bay Y will not be responsible for damage to, or loss of, personal property.
2. Only children ages 13 and older may be dismissed by themselves with prior written parental/guardian approval.
3. I hereby give permission for my child to be photographed/videotaped for promotional purposes.
4. I hereby give permission for my child to participate in all general program activities.
5. Our program hours are from 8:00AM to 5:30 PM.
6. Late arrival policy fee: For arrival after 5:30pm, a fee of $1 per minute will be charged, unless the late stay option was selected and paid for.
7. It is the goal of our program to provide a healthy and safe environment for all participants. If a participant displays any inappropriate behavior, or endangers the health and safety of participants or staff, we will contact the parent/guardian to immediately come to the site. We may suspend the participant from the program or consider permanent termination in extreme situations.
I have read the terms of enrollment and agree to abide by them.
Release: I hereby give my permission for my child to participate in all programs, swimming activities and trips as part of the Mini-Camp. I understand and fully recognize that risks are involved and I hereby release the Kings Bay Y or any of its sponsors, benefactors, or employees from any liability arising out of any injury to my child in the event of a medical emergency or surgical emergency. I do hereby give authority to the day camp and staff to obtain necessary emergency medical treatment for my child with the understanding that the family will be notified as soon as possible. I grant permission to the physician designated by the Kings Bay Y to hospitalize, secure proper treatment for, and order injections, anesthesia or surgery for my child. Furthermore, I understand that payment for medical services is solely the family’s responsibility.
I hereby give permission to the Kings Bay Y Inc. to take photographs of me and/or my child to be shown in a video, brochure, advertisement, or internet display for purposes of promoting interest in the Kings Bay Y. I release the Kings Bay Y Inc. from any claims resulting from the pictures taken on, before, or after the date of this communication. I do hereby give permission for my child to participate in all camp activities, including off-ground activities. I authorize the Kings Bay Y Inc. to act as a parent surrogate on my behalf. I realize that itineraries and/or programs are subject to change prior to, and during, the mini-camp.

We are asking you to complete this form, stating the names of the individuals who are allowed to pick up your child from the MINI-CAMP program. Please be as thorough as possible with this list, as we will not allow your child to leave with anyone who isn’t named below. Also, please be advised that the person picking up your child must have a valid form of photo ID on them, such as a driver’s license, a passport or current school – issued ID. There will be NO exceptions.