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Red
Eft
Play

In signing this waiver you are agreeing to the services of Andrée Collier Zaleska, director of Red Eft Play, to provide nature-based education for your child, on the site of her property at 204 Kelly Road, Dummerston, Vermont. Andrée will be assisted in her work by qualified assistant-teachers, under contract with Red Eft Play.

Under Vermont law, Red Eft Play, LLC is a registered business which provides recreational programming for children, and not a school or a child care center.


Understanding of Risk

Red Eft Play and all of its teachers and assistants are trained, experienced, and committed to the safety of the children in our care. However, as in any outdoor experience, we cannot eliminate all risk from our programs.

The risks include, but are not limited to, insect and animal bites and stings, forces of nature such as lightning, illness, disease, extreme weather; and any hazard present in the wilderness including falling branches, sharp obects, and slippery surfaces.

In signing here, I hereby acknoledge that I have been advised and understand the inherent dangers of the wilderness, and therefore of the programs of Red Eft Play. I acknowledge and accept that these are beyond the control of the director and employees of Red Eft Play. I acknowledge and accept that participation in the program of Red Eft Play may entail unavoidable risk of personal injury, death, or damage to property.

I hereby assume all risks arising out of my child's participation in the activities and programs of Red Eft Play. I agree to indemnify and hold harmless the director, teachers and employees of Red Eft Play from and against all claims arising from any occurrence causing damage or injury to my child in the course of the program.

Medical Release

In signing here, I hereby give consent for Red Eft Play to administer routine medical care, standard First Aid for my child if it becomes necessary in the course of the program.

In the case of medical emergency, I hereby give consent to Red Eft Play to secure proper medical treatment, indluding emergency transportantion by ambulance to the nearest hospital. I understand that every effort will be made by Red Eft Play to reach the responsible parent or guardian before emergency measures are taken.

I further understand that I am responsible for all medical costs incurred in the case of a medical emergency at Red Eft Play. 

I hereby acknowledge that I have provided the director of Red Eft Play with all relevant information about my child's medical needs and conditions, required to ensure their safety and wellbeing while at Red Eft Play.

I understand that my printed name in the box below serves as my electronic signature, and gives consent for my child's emergency hostpitalization.

Food

In signing below, I agree to allow Red Eft Play to provide lunch and snacks to my child. I understand that all the food provided will be fresh, vegetarian, and cooked in a home kitchen. I understand that the risk of food-borne illness is small, but not impossible, and I hereby assume all risks associated with allowing my child to eat at Red Eft Play.


I affirm that my agreement, consent, acknowledgement and understanding of any and all of the above statement may be applied to all Red Eft Play programs, events, and gatherings that my child participates in for as long as my child attends Red Eft Play.







First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

Last Name*
Second Participant's Date of Birth*
Third Participant's Name

First Name*

Middle Name

Last Name*
Third Participant's Date of Birth*
Fourth Participant's Name

First Name*

Middle Name

Last Name*
Fourth Participant's Date of Birth*
Fifth Participant's Name

First Name*

Middle Name

Last Name*
Fifth Participant's Date of Birth*
Sixth Participant's Name

First Name*

Middle Name

Last Name*
Sixth Participant's Date of Birth*
Seventh Participant's Name

First Name*

Middle Name

Last Name*
Seventh Participant's Date of Birth*
Eighth Participant's Name

First Name*

Middle Name

Last Name*
Eighth Participant's Date of Birth*
Ninth Participant's Name

First Name*

Middle Name

Last Name*
Ninth Participant's Date of Birth*
Tenth Participant's Name

First Name*

Middle Name

Last Name*
Tenth Participant's Date of Birth*
Parent or Guardian's Email Address

Email*

Confirm Email*
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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.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Relationship*

Phone*
Parent or Guardian's Date of Birth*
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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