MEDICATION ADMINISTRATION INFORMATION
Whenever possible, parents and physicians are encouraged to schedule medication to be taken outside of Camp hours. If the Participant will need to take any medication(s) while participating in the Camp, the Participant must provide the following to the camp director prior to the commencement of camp: (1) written authorization from the prescribing physician(s); (2) the appropriate container(s) of medication(s) in properly labeled pharmacy or manufacturer provided containers; and (3) any supplies necessary to administer the medications. Parents/legal guardians may delegate the administration of medications to Camp staff, but it should be noted that Camp staff are not medical professionals. By signing this Form, I am authorizing the Camp to administer the medication(s) to the Participant.
Accuracy Of Information: Information about the Participant contained on this Form and provided in addition to this Form is correct and current to the best of my knowledge. I understand and agree that if the Participant’s health information, insurance, or emergency contact information changes after the completion of this Form, or at any time during the Camp, I will promptly provide updated information to the camp director.
AUTHORIZATION FOR TREATMENT
In case of a health problem or emergency, I authorize the Camp to administer first aid and, where necessary: to transport the Participant to the nearest hospital emergency room; to order X-rays, routine tests, and treatment; and to release any records necessary for care or insurance purposes. I understand that the Camp or its employees or representatives will, to the extent reasonably possible, consult with me concerning any medical care to be provided to the Participant. Absent my direct instructions, I hereby authorize the Camp’s employees or representatives to permit commencement of medical treatment or hospital care (including necessary transportation and sharing of any relevant health information that may assist in providing medical care) when, in the judgment of the medical personnel involved, such treatment is medically necessary, even if I have not yet been consulted. In authorizing such emergency treatment, I agree to accept the determination of the treating medical personnel that the treatment or care rendered was medically necessary to protect the life, health, or mental well-being of the Participant. I hereby agree to bear all costs incurred as a result of the foregoing.
PARENTAL PERMISSION AND CONSENT TO PARTICIPATE
In consideration of the Participant’s participation in Camp, I, the undersigned, acknowledge, understand, and agree as follows:
The Participant has my permission to participate in the Camp and all Camp activities, and in the 2023 Atlanta Girls’ Camp Registration Form. By signing this Form, I acknowledge that I have had the
opportunity to ask questions and obtain whatever information I require to fully inform myself about the Camp, including the risks that the Participant may be exposed to in Camp, including, but not limited to, risks associated with COVID-19.
I have considered and disclosed to the Camp all physical or mental health conditions, and any risks associated with any such conditions, that could potentially affect the Participant’s ability to safely participate in the Camp. My permission for the Participant to participate in the Camp is based upon my belief that the Participant does not have a physical or mental health condition that could affect the Participant’s ability to safely participate in the Camp. If any such concerns arise, I agree to promptly disclose them and any risks associated with them to the Camp.
Even though there are risks associated with participation in the Camp and the possibility of additional risks of which neither the Camp nor I may be aware, I represent and warrant that I have enrolled the Participant in any and all insurance, including, but not limited to, health care, accident, and personal property insurance that I believe, in my sole judgment, is necessary to protect the Participant and the Participant’s interests while participating in the Camp.
PARENTAL RELEASE, ASSUMPTION OF RISK, AND INDEMNIFICATION
I understand that the Participant’s participation in the Camp may expose the Participant to certain risks including, without limitation: inappropriate conduct or negligence by self or others; misjudgment by self or others; overexposure to natural elements; participants’ mental, physical, or emotional conditions (known or unknown, disclosed or undisclosed); falling down or slipping; animal hazards, such as stings, bites, poisoning, and blows; drowning; risks related to swimming or playing in water, which may not be supervised; acts of God; dangerous road conditions and transportation problems while traveling to/from the Camp and Camp activities; contraction of communicable illness (including, but not limited to, COVID-19); and other risks associated with engaging in recreational activities and sports. In consideration of the Participant being allowed to participate in the Camp, I, the undersigned, expressly acknowledge, understand, and agree to the following:
RELEASE. I agree, on my own behalf and that of the Participant and our heirs, executors, administrators, personal representatives, and/or assigns (“Releasors”), to forever release, acquit, discharge, covenant to hold harmless and covenant not to sue Atlanta Girls’ School, Inc. (including, the Camp), its trustees, employees, volunteers, representatives, and agents (“Releasees”) from any and all claims, suits, liabilities, and actions, including, but not limited to, any negligence of the Releasees, which Releasors may have, now or in the future, which arise directly or indirectly out of the Participant’s participation in the Camp.
I understand that this Release includes, but is not limited to, any and all claims, suits, liabilities, and actions, that may arise directly or indirectly out of (a) the financial losses that I or the Participant may incur in connection with the cancellation or rescheduling of the Camp; (b) any services related to the special or emergency needs of the Participant while participating in the Camp; and/or (c) any authorized administration or assistance in administration of medications to the Participant.
ASSUMPTION OF RISK. I am familiar with the Camp programs and I fully understand, accept, recognize, and appreciate the risks and danger associated with the Participant’s participation in the Camp, including, but not limited to, the risks identified above. I recognize that certain Camp activities have risks inherent in, and specific to, participation, and that such risks cannot be eliminated without destroying the unique character of such activities. I recognize that participation in the Camp could result in property loss or damage, serious bodily injury, contraction of communicable illness (including, but not limited to, COVID-19), paralysis, and even death. While particular rules, equipment, and personal behavior may reduce the likelihood of injury, the risks and dangers of bodily injury still remain. I hereby knowingly and freely assume, on behalf of myself and the Participant, all risks, both known and unknown, associated with participation in the Camp.
INDEMNIFICATION. I hereby agree, on behalf of myself and the Participant, to indemnify the Releasees from and against any and all demands, claims, suits, actions, causes of action, or liabilities, including attorneys’ fees, brought by any person or entity, arising directly or indirectly from the
Participant’s participation in the Camp, including, but not limited to, any injury of any person or damage to or destruction of any property caused by the Participant.
WAIVER. To the extent any claim is made by any person or entity against any of the Releasees in connection with the Participant’s participation in any Camp activities, I hereby waive, on behalf of myself and the Participant, any claim for, or right to, monetary damages or any other form of personal relief.
The provisions contained above include any property or personal loss or damage, or other loss caused or alleged to be caused, in whole or in part, by the ordinary negligence (but not gross negligence) of the Releasees. These provisions are not intended to, and do not, govern any claims that cannot be released by private agreement.
MISCELLANEOUS. I hereby expressly agree that the provisions contained in this Form are intended to be as broad and inclusive as permitted by the laws of the State of Georgia and that if any portion hereof is held invalid or unenforceable, I agree that the balance shall continue in full legal force and effect. I agree
that this Form and all claims arising out of this Form or the Participant’s participation in the Camp shall be governed by Georgia law. I agree that the federal and state courts of Georgia shall be the exclusive forum for any claim arising out of this Form or the Participant’s participation in the Camp, and I hereby consent to the personal jurisdiction of such courts.
* * * * *
I, the undersigned, have read the entirety of this Form and I have satisfied myself that I understand what it means. By signing this Form, I affirm that I have legal custody of the Participant, am authorized to sign on the Participant’s behalf, and have decided to allow the Participant to participate in the Camp with full knowledge that the Releasees will not be liable for any personal injury or property damage the Participant may suffer, or cause, while participating in the Camp.
I understand that this Form may be electronically signed, and by indicating my assent below, I am agreeing to the use of electronic signatures. I understand and agree that my electronic signature will have the same legal effect and validity as a written signature, and that this Form is valid and will be given the same legal effect as a written and signed Form. I understand that if I do not want to execute this Form electronically, I can request a hardcopy version of the Form from the camp director.