March Break Day Camp | INT: Island Nature Trust

Current Participant Information
Participant Registration
Billing Information
Event Fee
Complete

Legal Parent or Guardian Information

First Name

Last Name

Phone Number

Number of Participants Under 12

Camp Hours

Please note the regular hours of the event are 8:30-3:30pm. If you will be using early drop off (7:30-8:30am) or late pick up (3:30-4:30pm) please let us know below.

Camp Hours

Regular Drop Off and Pick Up (8:30am-3:30pm)

Early Drop Off and Late Pick Up (7:30am-4:30pm)

Early Drop Off and Regular Pick Up (7:30am-3:30pm)

Regular Drop Off and Late Pick Up (8:30-4:30pm)

WAIVER OF LIABILITY FOR EVENT PARTICIPANTS – MINORS

I (we) do hereby acknowledge and agree:

That in all activities there is an element of risk. While the Island Nature Trust (herein called “the Trust”) takes all reasonable precautions to minimize these risks, there is no guarantee against injury or loss.

That my (our) child/ward is in good health and is capable of participating in the event.

Participants are expected to conduct themselves in a safe manner and abide by the instructions given by representatives of the Trust. Anyone who does not or whose actions jeopardize the safety, or the safety of the group, will be dealt with immediately. If appropriate, your child/ward may be asked to leave and/or sent home at the expense of parents/guardians.

I understand that in participating in this event, there exist risks of injury or personal harm. On behalf of myself, my heirs, personal representatives or executors, I hereby release, discharge, indemnify and hold harmless the Trust, including its volunteers, directors, employees and agents from any and all claims, causes of action or demands of any nature or cause, even though such injuries and damages may result from the negligence of the Trust, its volunteers, directors, employees and agents; including costs and attorney fees incurred or sustained by my child/ward in any way connected with my child/ward’s participation arising out of activities of the Trust including but not limited to accidents or injuries.

In the event of an accident or medical problem suffered by my child/ward, I consent to allow the Trust, it’s staff and agents to: share health information, provide first aid, and/or obtain medical care or services as needed using their best judgement for the health and safety of my child/ward.

I, on my own behalf and/or on behalf of my child(dren)/ward(s):

Give my permission as set out above

DO NOT give my permission as set out above.

PUBLIC RELATIONS AND IMAGE RELEASE

On behalf of myself, my heirs, personal representatives and executors, I agree to allow the Trust to use any photographs, films, videotapes or other visual representations taken of my child/ward in during the participation in events as aids in public relations efforts. I (we), on my own behalf and/or on behalf of my child/ward assign and transfer to the Trust any and all proprietary rights, including copyright, and waive all personality rights, which I (we) may have or my child/ward may have in this material.

I, on my own behalf and/or on behalf of my child(dren)/ward(s):

Give my permission as set out above

DO NOT give my permission as set out above.

Emergency Contact Information

During the duration of the activity, I may be reached at:

Phone Number

Alternate Phone Number

Relationship to participant(s)

Secondary Emergency Contact

In the event of an emergency, if I cannot be reached, the following person is hereby authorized to act on my behalf:

Contact Name

Phone Number

Alternate Phone Number

Relationship to participant(s)

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