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These forms are required for your children to attend JOC's youth programs.

JUPITER OUTDOOR CENTER, INC.

RELEASE OF LIABILITY AND WAIVER

PLEASE READ THIS RELEASE OF LIABILITY AND WAIVER FORM CAREFULLY BEFORE SIGNING

I understand that outdoor recreational activities involve inherent risk, and I may be exposed to dangers and hazards, known and unknown, including, but not limited to the following: falls, fractures, concussions, dangerous weather, overexertion, overheating, injuries from my lack of fitness or conditioning, sunburn, dehydration, lightning and rapid weather change, unpredictable ocean and river currents and conditions, hypothermia, hostile or aggressive wildlife, dangerous plant life, bacteria, amoebas, and marine life forms, drowning, death, equipment failures, and negligence of JOC or others.

By signing this document, YOU ARE EXPRESSLY AGREEING TO HAVE KNOWLINGLY, FULLY AND TOTALLY RELEASED Jupiter Outdoor Center, Inc, its agents and employees (referred to as “JOC”) and Palm Beach County, its agents, employees and elected officials (hereinafter together with JOC referred to as the “the Released”) FROM ANY AND ALL CLAIMS, INCLUDING ACTIVE OR PASSIVE NEGLIGENCE BUT EXCLUDING GROSS NEGLIGENCE AND/OR INTENTIONAL MISCONDUCT, arising out of any act, omission, or condition existing prior to the signing of the agreement, and extending to include any act, omission, or condition in any way connected with your participation in (including transit to and from) these water sports activities, occurring at any point in the future from the activities in which you are about to engage. THIS WAIVER AND RELEASE OF LIABILITY IS EXPRESSLY PROVIDED TO EXCULPATE THE RELEASED FROM THOSE LIABILITIES WHICH ARE SEPARATE FROM AND IN ADDITION TO THE POTENTIAL LIABILITIES CREATED BY THE RISKS INHERENT IN WATER SPORTS PARTICIPATION. Furthermore, by initialing and signing this waiver below, you are binding your spouse, heirs, assigns, and any similarly situated personal or legal representative to the waiver’s terms.

I HEREBY ASSUME FULL RESPONSIBILITY FOR ANY RISK OF BODILY INJURY, DEATH OR PROPERTY DAMAGE DUE TO THE NEGLIGENCE OF THE RELEASED.

By executing this WAIVER below, you are further agreeing to hold harmless and to indemnify the Released against any and all claims, demands, losses, damages, causes of action, judgments, costs, expenses, attorneys’ fees, and other liabilities, including those from third parties, arising out of or relating to your participation in any water sports and/or presence upon the property on which they are located, even if caused by the active or passive negligence of the Released, but excluding any gross negligence or intentional misconduct. By agreeing to indemnify the Released for the acts, occurrences, and expenses as contained within this subsection you are knowingly and voluntarily agreeing that you may be required to reimburse or provide the cost of a legal defense or representation for the Released for any expenses or actions it has to take arising out of your participation in these water sports activities.

I agree that the use of equipment furnished by JOC constitutes an acceptance of said equipment on a lease basis “As Is” and agree to return all rental equipment in its present condition, with the exception of ordinary wear and tear. I further agree to utilize the life preserver provided by JOC and to only participate in the outdoor activities if I and my entire party uses the life preservers as instructed by JOC, acknowledging that the proper use thereof is our responsibility. I agree to reimburse JOC the retail replacement value of any equipment that is damaged during my use.

I understand that I may be photographed or videotaped. To the fullest extent allowed by law, I waive all rights of publicity or privacy or pre-approval that I have for any such likeness of me or use of my name in connection with such likeness, and I grant to JOC and its assigns permission to copyright, use, and publish (including by electronic means) such likeness of me, whether in whole or part, in any form, without restrictions, and for any purpose.

This Agreement shall be governed by and construed in accordance with the domestic substantive laws of the State of Florida without giving effect to any choice or conflict of law provision or rule that would cause the application of the domestic substantive laws of any other jurisdiction. Each of the parties agrees that all actions, suits or proceedings arising out of or based upon this Agreement or the subject matter hereof shall be brought and maintained exclusively in the federal and state courts of the State of Florida located in the County of Palm Beach. Each of the parties hereto by execution hereof hereby irrevocably submits to the jurisdiction of the federal and state courts in the State of Florida located in the County of Palm Beach, for the purpose of any action, suit or proceeding arising out of or based upon this Agreement or the subject matter hereof. Each of the parties hereto hereby consents to service of process in any such suit, action or proceeding in any manner permitted by the laws of the State of Florida. The provisions of this section shall not restrict the ability of any party to enforce in any court any judgment obtained hereunder.

ANY HALF DAY CAMPER NOT PICKED UP BY 2:00 PM WILL INCUR A LATE FEE OF $10 PER HOUR FOR EACH HOUR PAST PICKUP TIME ($10 MINIMUM AFTER 2:15 PM)

ANY FULL DAY CAMPER NOT PICKED UP BY 5:00 PM WILL INCUR A LATE FEE OF $10.

ANY CAMPER REMAINING AFTER 6:00 PM WILL INCUR A $1 PER MINUTE CHARGE 

Waiver of Liability Relating to Coronavirus/COVID-19

The novel coronavirus (“COVID-19”) has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. As a result, federal, state, and local governments and federal and state health agencies recommend social distancing and have, in many locations, prohibited the congregation of groups of people. Jupiter Outdoor Center, Inc. has put in place preventative measures to reduce the spread of COVID-19; however, we cannot guarantee that you will not become infected with COVID-19. Further, attending any program or activity at Jupiter Outdoor Center, Inc. could increase your risk of contracting COVID-19.

By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that I may be exposed to or infected by COVID-19 while participating in activities at Jupiter Outdoor Center, Inc. and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at Jupiter Outdoor Center, Inc. may result from the actions, omissions, or negligence of myself and others, including, but not limited to, Jupiter Outdoor Center, Inc. employees, volunteers, and program participants and their families. 

I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, (“Claims”) that I may experience or incur in connection with my attendance at Jupiter Outdoor Center, Inc. On my behalf, I hereby release, covenant not to sue, discharge, and hold harmless Jupiter Outdoor Center, Inc., its employees, agents, and representatives, of and from all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of Jupiter Outdoor Center, Inc., its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after attending any Jupiter Outdoor Center, Inc. program or activity.

Please select who will be participating...
Minor
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First Camper Name Name

First Name*

Last Name*

Phone*
First Camper Name Date of Birth*
I certify that I am 18 years of age or older
First Camper Name first, last
Are you a returning camper?*
No
Yes

Emergency Contact/Authorized Pickup Parents cannot be listed as emergency contacts. List the name of at least one person who can be contacted in the event of an emergency or illness if you cannot be reached. *
First Camper Name Signature*
Camper Name Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail. NO MORE THAN ONE EMAIL PER MONTH
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Insurance

Insurance Carrier*

Insurance Policy Number*
Who else can pick up your child?

Other than you, who is authorized to pick up your child?
Is there a court order prohibiting a parent from picking up the child?*
No
Yes

If yes, please enter name of prohibited parent
Medical Information

Physician Name

Physician Phone Number
Does your child have any food, medication, or environmental allergies?*
No
Yes

Please list and explain any allergies or dietary restrictions
Does your child have a special health or medical condition? (physical, mental, psychological)?*
No
Yes

If yes, please explain
Does the camper have any activity limitations because of health?*
No
Yes

If yes, please explain
Medical Transportation Statement
I, parent, or legal guardian of camper, authorize the transportation of camper for medical treatment. I further understand that I shall be responsible for any and all costs associated with the transportation of camper. Finally, I authorize medical treatment for the camper, at my cost, if the need arises. *
CHECK HERE TO AGREE
First Aid & Medications
Counselors trained and certified in First Aid/CPR will be with the camp group at all times, as well as fully supplied first aid kits. The scope and authority of our immediate camp staff is limited to basic lifesaving practices, first-aid and CPR. Any incidents beyond that scope will be referred to emergency medical services. For all injuries/illness incurred at camp, that JOC Camp Staff is made aware of, including minor injuries/illnesses, a camper's parent/guardian will be notified of that injury/illness. Depending on the severity of the incident, the camper's parent or guardian may be called, while minor scrapes and injuries may be communicated at the time of camper pick up. For any incidents requiring emergency services be called to respond, the parent/guardian will be contacted as rapidly as possible. It is the policy of the Jupiter Outdoor Center that our camp staff WILL NOT ADMINISTER prescription medications to camp participants (campers). Over-the-counter medications, unless a specific need arises while performing first-aid, will also not be administered by JOC staff. If a camper(s) requires medication, it is recommended that medication be administered by their parent or legal guardian prior to the beginning of camp and/or after the camp program has ended. *
CHECK HERE TO AGREE
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above. Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above. NOTICE TO THE MINOR CHILD’S NATURAL GUARDIAN READ THIS FORM COMPLETELY AND CAREFULLY. YOU ARE AGREEING TO LET YOUR MINOR CHILD ENGAGE IN A POTENTIALLY DANGEROUS ACTIVITY. YOU ARE AGREEING THAT, EVEN IF JUPITER OUTDOOR CENTER, INC. USES REASONABLE CARE IN PROVIDING THIS ACTIVITY, THERE IS A CHANCE YOUR CHILD MAY BE SERIOUSLY INJURED OR KILLED BY PARTICIPATING IN THIS ACTIVITY BECAUSE THERE ARE CERTAIN DANGERS INHERENT IN THE ACTIVITY WHICH CANNOT BE AVOIDED OR ELIMINATED. BY SIGNING THIS FORM YOU ARE GIVING UP YOUR CHILD’S RIGHT AND YOUR RIGHT TO RECOVER FROM JUPITER OUTDOOR CENTER, INC. IN A LAWSUIT FOR ANY PERSONAL INJURY, INCLUDING DEATH, TO YOUR CHILD OR ANY PROPERTY DAMAGE THAT RESULTS FROM THE RISKS THAT ARE A NATURAL PART OF THE ACTIVITY. YOU HAVE THE RIGHT TO REFUSE TO SIGN THIS FORM, AND JUPITER OUTDOOR CENTER, INC. HAS THE RIGHT TO REFUSE TO LET YOUR CHILD PARTICIPATE IF YOU DO NOT SIGN THIS FORM. EFFECT OF FLORIDA LAW UPON ABILITY TO WAIVE CLAIMS BY MINOR CHILDREN This supplemental waiver for minor children does not waive your minor child’s ability to recover against the Released for injuries, damages, or other loss occurring to the minor child, brought on behalf of the minor child by either you as natural guardian, personal representative, or guardian ad litem based on the negligence of the Released. By initialing this section and signing the waiver below, you are knowingly and voluntarily agreeing, and expressly acknowledging, that you have read the statement above regarding the waiver of your ability, as well as that of your minor child or his/her representative, to recover against the Released for any PERSONAL INJURY, INCLUDING DEATH, TO YOUR CHILD OR ANY PROPERTY DAMAGE THAT RESULTS FROM THE RISKS THAT ARE A NATURAL PART OF THE ACTIVITY. As provided by Fla. Stat. §744.301(3)(b) (2018), the term natural risk or otherwise construed as an “inherent risk” of the activity means those dangers or conditions, known or unknown, which are characteristic of, intrinsic to, or an integral part of the activity and which are not eliminated even if the activity provider acts with due care in a reasonably prudent manner. The term includes, but is not limited to the failure by the activity provider to warn the natural guardian or minor child of an inherent risk; and the risk that the minor child or another participant in the activity may act in a negligent or intentional manner and contribute to the injury or death of the minor child. The scope of this supplemental waiver shall be coextensive with that of the Adult Participant Waiver to the fullest extent allowed by state law. I understand that my minor child (or children) may be photographed or videotaped. To the fullest extent allowed by law, on behalf of my minor child (or children) I waive all rights of publicity or privacy or pre-approval that my child (or children) or I have for any such likeness of them and I grant to JOC and its assigns permission to copyright, use, and publish (including by electronic means) such likeness of my child (or children), whether in whole or part, in any form, without restrictions, and for any purpose. NATURAL GUARDIAN’S ACKNOWLEDGEMENT OF LIMITED RELEASE ON BEHALF OF MINOR CHILD Your signature below reflects your express assent to be bound to the terms of this supplemental agreement for your minor child. Your signature also represents your attestation to being the natural guardian of the minor child(ren) listed below, and possessing the legal authority to sign this agreement on their behalf. Please carefully review each section again and ensure that you fully understand the implications of this agreement. PARENTAL CONSENT: I am the minor’s parent or guardian named above and I understand the nature of the Waiver of Liability above and verify and consent to the minor attending Jupiter Outdoor Center, Inc. On the minor’s behalf, I hereby release, covenant not to sue, discharge, and hold harmless Jupiter Outdoor Center, Inc., its employees, agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. On behalf of the minor, I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of Jupiter Outdoor Center, Inc., its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after attending in any Jupiter Outdoor Center, Inc. program or activity.
Parent or Guardian's Name

First Name*

Last Name*

Relationship*

Phone*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's first, last
Are you a returning camper?*
No
Yes

Emergency Contact/Authorized Pickup Parents cannot be listed as emergency contacts. List the name of at least one person who can be contacted in the event of an emergency or illness if you cannot be reached. *
Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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