REGISTRATION FORM

Please provide a contact other than a parent in case of an emergency.

Please provide the names of anyone other than the parent/guardian that are authorized to pick up or sign out the camper

The following information will be submitted to our campsite host, Camp Nawakwa. In accordance with the American Camping Association and the Laws of the State of California, we must have a Health History/Medical Consent Form completed and signed by the parent or legal guardian for each camper under age 18 attending Camp Nawakwa. Your camper cannot begin the program unless this form is completed and the required signatures are provided. Please be aware that Camp Nawakwa does NOT provide medical or hospital insurance coverage. Camp Nawakwa REQUIRES this information in order to provide appropriate medical care in the event of injury and/or illness while at camp. Camp Spin Off and Camp Nawakwa are committed to protecting the confidentiality of this information.

REQUIRED: Select "Yes" or "No" for each statement. Explain “Yes” answers below. Has/does the camper:

The State of California and County law require an accurate record of the camper's current immunization status. All campers must provide documentation of the administration of at least the first doses of MMR (Measles, Mumps, Rubella), Tdap/dtap (Tetanus, Diphtheria, Pertussis), and Meningitis prior to attending/participating in Camp Spin Off. Individuals that do not provide immunization records or do not have up-to-date vaccinations will not be allowed to attend Camp Spin Off.

By signing this form I give my informed consent to the First Aid personnel assigned by Camp Nawakwa. who are certified in a minimum of CPR and First Aid by a nationally recognized provider to provide basic First Aid and comfort measures through standardized camp treatment procedures which includes the use of over-the-counter medications. I understand that it is my responsibility to make arrangements for a camper with greater health care needs than the First Aid personnel can provide within their individual certifications, licenses and scopes of practice. I authorize Camp Nawakwa. to arrange for or provide any necessary related transportation to the nearest medical facility for urgent or emergency medical treatment if indicated, and I do assume all responsibility for payment for such treatment. I hereby give permission to the physician selected by Camp Nawakwa. to secure and administer any and all medical treatment deemed necessary for my child, including hospitalization. This completed form may be photocopied for trips away from Camp Nawakwa. properties. I authorize the use of the following generic, over-the-counter medications as directed by the labels provided by the manufacturer for my child: analgesics, decongestants, antihistamines, cough suppressant, throat lozenges, epi-pen, antacid, antibiotic ointment, hydrocortisone cream, burn cream, petroleum jelly, chapped skin/lip treatment, antiseptic skin and wound cleansers, glucose, laxatives, electrolyte replacement fluids. Below I will list any exceptions. I understand that these are stocked and dispensed by the First Aid personnel free of charge as needed for the comfort of my child. I have requested Camp Nawakwa to allow my child to participate in any and all activities that may include but are not limited to those outlined in the camp brochure. As a condition of receiving this benefit, I do hereby agree to the following: I understand that my child’s participation in these activities can expose him/her to dangers both from known and unanticipated risks. Acknowledging that such risks exist, I on behalf of myself, my child and any other party who may have the right to assert any rights for or on behalf of my child, do hereby forever release and discharge, indemnify and hold harmless Camp Nawakwa, its affiliates, officers, directors, agents, employees, insurers, successors in interest, attorneys, or any other person or persons associated with any or all of them who might be liable (the “Released Parties”) from and against any and all claims, causes of action, actions, suits, demands, losses, damages, expenses, costs or liability (collectively, “Losses”) arising from or in connection with my child’s participation in Camp Nawakwa camp and its activities, including Losses arising from the negligence of any of the Released Parties, whether such Losses arise in connection with bodily injury (including death), property damage or otherwise (collectively, the “Released Claims”). The Released Claims include Losses arising out of any condition of the premises at which the camp activities are held or the conduct of any person in connection with the preparation for, supervision of, or conduct of any activity, whether planned or unplanned. In the event that child abuse is reported while your camper is at Camp Nawakwa, we may fully cooperate with Child Protective Services and Law Enforcement for the best interest of the child. I further understand and acknowledge that I make this release in full accord and satisfaction of and in compromise of any and all Released Claims. I represent and acknowledge that I have read and understand this form and the release granted above and warrant that all statements made herein are true to the best of my knowledge. I have read and understand this entire form and by signing below agree to the terms herein.

I hereby give my full consent to Camp Spin Off and it’s affiliates to record (video, photograph, audio recording or other) my child's participation in any programs or events associated with Camp Spin Off. Further, I hereby transfer and assign to Camp Spin Off the exclusive rights to use and to authorize others to use said images, video, photography, audio recordings or other, for promotional and educational use in the future. I understand that my child’s image, voice or video recording may be used, but my name or personal information will never be shared publicly without additional, separate consent.

Camp Spin Off practices a “zero tolerance” policy when it comes to alcohol, illegal drugs, tobacco products, misuse of prescription drugs, weapons and sexual misconduct. We reserve the right to dismiss any camper whose action, behavior or attitude, in our judgment, is contrary to the best interest of the camp. If Camp Spin Off or Camp Nawakwa staff has any suspicions of drug use, all campers will be subject to a bag search. Campers in violation of this policy will be sent home at their own expense. No refunds will be granted. Please keep this in mind while packing for camp.

I have requested Camp Spin Off and Camp Nawakwa. to allow my child to participate in any and all activities that may include but are not limited to those outlined on the Camp Spin Off website. As a condition of receiving this benefit, I do hereby agree to the following: I understand that my child's participation in these activities can expose him/her to dangers both from known and unanticipated risks. Acknowledging that such risks exist, I on behalf of myself, my child and any other party who may have the right to assert any rights for or on behalf of my child, do hereby forever release and discharge, indemnify and hold harmless Camp Spin Off and Camp Nawakwa, its affiliates, officers, directors, agents, employees, insurers, successors in interest, attorneys, or any other person or persons associated with any or all of them who might be liable (the "Released Parties") from and against any and all claims, causes of action, actions, suits, demands, losses, damages, expenses, costs or liability (collectively, "Losses") arising from or in connection with my child's participation in Camp Spin Off/Camp Nawakwa's camp and its activities, including Losses arising from the negligence of any of the Released Parties, whether such Losses arise in connection with bodily injury (including death), property damage or otherwise (collectively, the "Released Claims"). The Released Claims include Losses arising out of any condition of the premises at which the camp activities are held or the conduct of any person in connection with the preparation for, supervision of, or conduct of any activity, whether planned or unplanned. In the event that child abuse is reported while your camper is at Camp Nawakwa, we may fully cooperate with Child Protective Services and Law Enforcement for the best interest of the child.

I, as the parent and/or guardian of the individual named in this form giving permission for his/her attendance at Camp Spin Off, located at Camp Nawakwa on the dates specified herein, except for willful misconduct or gross negligence of Camp Spin Off or Camp Nawakwa, its directors, officers, staff or any other persons connected therewith, agree to indemnify and hold Camp Spin Off or Camp Nawakwa, and each of the persons connected therewith, harmless for injury or damage to the person or property of said individual. All references to "attendee" or "camper" are deemed to be one and the same as "my child". I further understand and acknowledge that I make this release in full accord and satisfaction of and in compromise of any and all Released Claims. I represent and acknowledge that I have read and understand this form and the release granted above and warrant that all statements made herein are true to the best of my knowledge. I have read and understand this entire form and by signing below agree to the terms herein.

Payment Plans are only available at the Standard Tuition Rate ($1499). Automatic payments can be billed on a monthly, twice-monthly or quarterly basis. The initial $100 minimum deposit is nonrefundable starts you on a payment plan. You may make a deposit amount greater than $100 if you wish. Please contact [email protected] with any questions regarding the payment plans.