Additional Information, Waiver and Permission Form

I give permission for the Camp Nurse/Cypress Hills Staff to give over the counter medication to my child/camper as needed. The nurse will try to contact the parent/guardian to update them on the camper’s condition as needed.

1. This is a binding legal agreement; therefore clarify any questions or concerns before signing. As a Participant in camps, events, programs, and activities organized, operated or conducted by Cypress Hills Camp (collectively the “Events”), the undersigned, being the Participant and the Parent/Guardian of the Participant (collectively the “Parties”) acknowledge and agree to the following terms:

Disclaimer
2. Cypress Hills Camp and its directors, officers, committee members, members, employees, volunteers, participants, agents and representatives (collectively the “Organization”) are not responsible for any injury, personal injury, damage, property damage, expense, loss of income, or loss of any kind suffered by a Participant during, or as a result of, participating with the Organization and/or in any Events, caused by the risks, dangers and hazards associated with the Organization and/or the Events.

Description of Risks
3. The Participant is participating voluntarily with the Organization and/or in the Events. In consideration of the Participant’s participation in with the Organization and/or in the Events, the Parties hereby acknowledge that they are aware of the risks, dangers and hazards and may be exposed to such risks, dangers, and hazards. The risks, dangers, and hazards include, but are not limited to, injuries from participating in or with the following activities or equipment:

Archery, Arts and Crafts, Barn Activities, Basketball, Canoeing/Kayaking, Flag/Touch Football, Frisbee Golf, Gaga Ball, Geocaching, Group Games, Hiking, Horseback Riding, Mountain Boarding, Mountain Biking, RC Trucks, Swimming – Lake, Swimming – Pool, Trampoline, Volleyball, Music/Band, Paintball*

4. The risks, dangers, and hazards also include, but are not limited to, injuries from:

a.) Failing to comply with the rules established for participation
b) Bad weather conditions including hypothermia, sunstroke, or dehydration
c) Vigorous physical exertion, rapid movements, and quick turns and stops
d) Failing to remain within designated areas and supervised activities
e) Failure to properly use any piece of equipment or from the mechanical failure of any piece of equipment
f) Contact, colliding, falling or being struck by other participants, equipment or the ground
g) Blindness, deafness, spinal cord injuries which may render me permanently paralyzed and death h) Travel to and from Events which are an integral part of the Organization’s Events
Furthermore, the Parties are aware:
a) That the Participant’s risk of injury is reduced if he or she follows all rules established for participation; and
b) That the Participant’s risk of injury increases as he or she becomes fatigued.
c) That injuries sustained can be severe;

Release of Liability
5. In consideration of the Organization allowing the Participant to participate, the Parties agree:

a) To freely accept and fully assume all such risks, dangers and hazards and possibility of personal injury, death, property damage, expense and related loss, including loss of income, resulting from participating with the Organization and/or in the Events; and
b) To forever release the Organization from any and all liability for any and all claims, demands, actions and costs that might arise out of the Participant’s participation with the Organization and/or in the Events, or from the physical risks associated with same.

Acknowledgement
6. The Parties acknowledge that they have read this agreement and understand it, that they have executed this agreement voluntarily, and that this Agreement is to be binding upon themselves, their heirs, executors, administrators and representatives.