Thank you + Participation Release Form

Thank you for registering for Summer Camp!

Please complete the Participation Release Form below:

Participation/Release Form - Summer Camp

  • The parent or guardian above gives permission for the child:

  • to participate in the Earth Arts Ithaca LLC Programs. (hereafter referred to as EAILLC) Provided parents and emergency contacts cannot be reached, I hereby voluntarily consent to the rendering of such care including diagnostic procedures, medical treatment, by authorizing members of a hospital staff or their designees, as may in their professional judgment be necessary. I hereby acknowledge that no guarantees have been made to me as the effect of such examinations or treatment on child’s condition. I acknowledge that I am responsible for all charges in connection with care rendered during this period.

  • In consideration of the services of EAILLC, their agents, owners, employees, volunteers, participants, or other persons acting in any capacity on their behalf, I hereby agree to release, indemnify, and discharge, EAILLC on behalf of myself, my spouse, my children, my parents, my heirs, assigns, personal representative and estate as follows:

  • I acknowledge that I have been advised and fully understand that there may be certain elements of danger inherent in activities sponsored by EAILLC, which are beyond their control, and that participation in these activities may entail unavoidable risk, personal injury, property damage, or fatal injury. These risks include, but are not limited to the use of equipment failure, individual and group activities, indoors and out. These may include, but are not limited to use of the art studio, tools, equipment, forces of nature such as, but not limited to lightening, and any hazard present in the wilderness, such as but not limited to, insect stings, animal bites, low lying branches, sticks, sharp objects, slipping, falling, exposure to weather conditions, and extreme temperatures. I hereby assume all risks of injury and hold harmless EAILLC from any and all claims and all liability, against claims arising from any occurrences causing damage to myself, my child, or any party participating in said event or any third parties injured as a result of my child’s actions, including any claims which acknowledge negligent acts or omissions of EAILLC.

  • EAILLC reserves the right to use any photographic, written, or video material by all participants taking part in programs. It is EAILLC policy not to list minor’s names in photos or videos .

  • By signing this document I acknowledge if anyone is hurt or property is damaged during my or my child’s participation in this activity, I may be found by a court of law to have waived my right to maintain a lawsuit against EAILLC on the basis of any claim from which I have released them herein.

  • I have carefully and sufficiently read this document, understand it, and agree to be bound by its terms.

  • (Please skip the adult participant section if only your child is participating. See the parent/guardian section below. Thank you!)
  • Parent’s or Guardian’s Additional Indemnification (for all participants under 18)

  • (list minor's name here)
  • being permitted to participate in its activities and to use its equipment and facilities, I further agree to indemnify and hold harmless EAILLC from any and all claims which are brought by or on behalf of myself, and which are in any way connected with such use of participation by minors.

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