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Keely's Camp COVID-19 & Liability Release Waiver

**Signature Required by Parent or Legal Guardian and by Camp Participant**

IN CONSIDERATION FOR (THE Participant) being allowed to participate in races, race training, big mountain freeskiing, free ski drills, dryland training, whitewater kayaking, mountain biking and other activities conducted by Keely’s Camp, LLC d/b/a Keely’s Camp for Girls we do hereby warrant, represent and agree as follows:

● Due to the 2019-2020 outbreak of the novel Coronavirus (COVID-19), Keely’s Camp for Girls is taking extra precautions with the care of every Participant to include health history review and enhanced procedures in accordance with the guidance from all locations where Keely's Camp Operates. 

Symptoms of COVID-19 include:

  • Fever
  • Fatigue
  • Cough
  • Difficulty Breathing or shortness of breath
  • Repeated shaking with chills
  • Muscle pain
  • Headache
  • Sore throat
  • Loss of taste or smell

I agree to the following: 

● I understand the above symptoms and affirm that the Participant, as well as all household members, do not currently have, nor have experienced the symptoms listed above WITHIN THE LAST 14 DAYS.

● I affirm that Participant, as well as all household members, have not been diagnosed with COVID-19 WITHIN THE PAST 30 DAYS. I affirm that Participant, as well as all household members, have not knowingly been exposed to anyone diagnosed with COVID-19 WITHIN THE PAST 30 DAYS.

● I understand that Keely’s Camp for Girls, its owner’s and Staff, including but not limited to Keely Kelleher cannot be held liable for any exposure to the COVID-19 virus caused by misinformation on this form or the health history provided by each Participant and their parent or legal guardian.

By signing below, I agree that each statement above is true and accurate to the best of my personal knowledge. As Parent or legal guardian of Participant, I do hereby release Keely’s Camp, LLC d/b/a Keely’s Camp for Girls and it’s staff, coaches, employees and owners, including Keely Kelleher “THE RELEASEE” from any and all liability for the exposure or harm due to COVID-19 that Participant or a member of her household may sustain while under the care, custody or supervision of Keely’s Camp for Girls or while participating with Keely’s Camp of Girls. This release covers all Covid-19 risks connected with such participation, whether foreseen or unforeseen. If I am signing on behalf of a minor, I recognize that I may not be able to release claims that a minor may have, HOWEVER, I agree to Indemnify and Hold Harmless THE RELEASEE from any claim by the Participant, his/her family, estate or heirs or household members arising out of his/her participation in race training, dry land training, or any other activity conducted by Keely’s Camp for Girls; further, we do hereby agree to Indemnify and Hold Harmless THE RELEASEE from any claim (including but not limited to claims for medical services and medical expenses) arising out of the Participants participation in races, race training, dry land training, or any other activity conducted by Keely’s Camp for Girls including reasonable attorney’s fees and the cost of the defense of any such claims.

We further agree to abide by all rules, regulations and guidelines adopted by the ski resort(s) and/or ski areas while participating in a camp operated by Keely’s Camp for Girls. In addition, we agree to immediately report to the staff of Keely’s Camp For Girls should any Participant or household member of Participant exhibit any symptoms of Covid-19 while participating in a program operated by Keely’s Camp for Girls or within two weeks after having participated in a program.

We further agree that Keely’s Camp for Girls, upon receipt of information that a participant or member of a participant’s household has been exposed to or contracted Covid-19, may disclose said information and any details to other participants and their family, though reasonable efforts will be used to protect the identity of the person exposed.

Guardian or Parent, or The Participant (If The Participant is under 18 years of age as of the date below, signature must be that of parent or legal guardian.)

Signature of Participant:



ALPINE RELEASE & WAIVER OF LIABILITY, ASSUMPTION OF RISK,
AND INDEMNITY AGREEMENT ("Agreement")

 

Date:  October 27, 2021

In consideration of myself OR my child participating in the snow ski related activities, and/or other activities, offered by Keely's Camp, LLC ("Activities") I represent that I do, on behalf of myself OR my child understand the nature of these Activities, and that I am and my child are qualified, are in good health, and in proper physical condition to participate in such Activities. I acknowledge on behalf of myself OR my child that if I OR my child believe event/Activity conditions are unsafe we will immediately discontinue in the Activities.
It is fully understood that these activities involve inherent risks and dangers of serious bodily injury, including permanent disability, paralysis and/or death, which may be caused by my OR my child's own actions or inactions, or those of others participating in the Activities, the conditions in which the Activities take place, or the negligence of the "releasees" named below, and there may be other risks either not known to me OR my child, or not readily foreseeable at this time; and I OR my child fully accept and assume all such risks and all responsibility for losses, costs and damages I OR my child might incur as a result of my OR my child's participation in the Activities.
I hereby agree for myself and for my child to release, discharge, indemnify and covenant not to sue Keely's Camp, LLC it's respective administrators, directors, agents, officers, volunteers, and employees, coaches, guides, any sponsors, advertisers, and, if applicable, owners and lessors of the premises on which the Activities take place (each considered one of the "Releasees" herein), and release and discharge them from all liability, claims, demands, losses, or damages on my account caused or alleged to be caused in whole or in part by the negligence of the "releasees" or otherwise, including negligent rescue operations; and I further agree that if, despite this release, waiver of liability, and assumption of risk, that I, or anyone on my behalf OR on behalf of my child, makes a claim against any of the Releasees. I will indemnify, save and hold harmless each of the Releasees from any loss, liability, damage, or cost which may incur as the result of such claim. 

I have read this RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT, and understand that I have given up substantial rights by signing it, and have signed it freely and without any inducement or assurance of any nature, and intend it to be a complete and unconditional release of all liability to the greatest extent allowed by law, and agree that if any portion of this agreement/release agreement is held to be invalid the balance, notwithstanding, shall continue in full force and effect. 

Signature of participant OR Parent/Legal Guardian (if participant/skier is a Minor child)

 


ALPINE RELEASE & WAIVER OF LIABILITY, ASSUMPTION OF RISK,
AND INDEMNITY AGREEMENT ("Agreement") continued...

 

Date: October 27, 2021

In consideration of myself OR my child being permitted to participate in any way in the alpine ski school/club activities ("Activities") of the above Alpine Ski School, I represent that I do, on behalf of myself OR my child: 

I. I acknowledge agree and represent I fully understand the nature of alpine skiing/ snowboarding and alpine ski school/ club activities, and that I am and my child (if applies) is qualified, in good health, and in proper physical condition to participate in such Activities. 
2. I fully understand that (a) Alpine skiing/ snowboarding and Alpine Ski School activities involve inherent risks and dangers of serious injury, and or death, (b) these risks and dangers may be caused by my own (or my child's) actions or inactions or omission, intentional or otherwise, or the actions or inactions of others participating in the Activities and/or the condition of which Activities take place. 
3. I hereby agree for myself and for my child (if applies), to release, discharge, indemnify and covenant not to sue, the above listed Alpine Ski School or it's parent organization, its respective administrators, directors, agents, officers, members, volunteers, and employees, any sponsors, advertisers, and, if applicable, owners and lessors of the premises of property on which the Activities take place (each considered one of the "Releasees" herein), from all liability claims, demands, losses or damages on my account caused or alleged to be caused in whole or in part by the "Releasees" or otherwise 
4. I fully accept and assume all such risks and all responsibility for losses, costs, and damages I incur as a result of my participation in the Activities. My signature signifies that I fully understand and agree to be bound by this Release and Waiver Agreement, for myself and for my underage child (if applicable), and agree that if any portion of this agreement is held to be invalid the balance, notwithstanding, shall continue in full force & effect. 

Participant's signature:

 


Keely’s Camp Covid 19 Guidelines – Parent & Athlete Signs and Symptoms of COVID 19 (from CDC)

  • Fatigue
  • Cough
  • Headache
  • Difficulty Breathing or shortness of breath
  • Fever
  • Repeated shaking or chills
  • Muscle Pain
  • Sore Throat
  • Loss of taste or smell

● This list is not all possible symptoms. Other less common symptoms have been reported, including gastrointestinal symptoms like nausea, vomiting, or diarrhea.
● I will notify Keely’s Camp if the athlete, as well as anyone in the household experienced COVID 19 symptoms listed above in the past 14 days.
● I will notify Keely’s Camp if the athlete, as well as, anyone in the household have tested positive for COVID 19 in the past 30 days.
● 
I will immediately notify Keely’s Camp if the athlete or someone in the athlete’s household begins to experience COVID 19 Symptoms or test positive for COVID 19 after leaving Keely’s Camp or during Keely’s Camp. 

  • I will talk with my daughter about ski resort or ski area protocols at all Keely's Camp locations.

 

Each day Keely’s Camp staff will review protocols with athletes:

● My daughter will wear a cloth face mask (buff), goggles/glasses, & gloves.
● If going indoors at the designated ski resort or ski area my daughter will follow the protocols for face coverings at said ski resort or ski area.
● My daughter will have their own water bottle, food/snacks, sunscreen and hand sanitizer on the hill each day labeled with my daughter’s name.
● My daughter is able to load/unload and download (if necessary) the chairlift without assistance.
● My daughter will do their best to abide by proper social distancing measures.
● My daughter will continue to practice good handwashing techniques and hygiene.
● My daughter will cover coughs and sneezes with a tissue or an elbow.

I agree to uphold the Keely’s Camp Covid 19 Guidelines:

I Agree

Date signed: October 27, 2021

First Campers Name

First Name*

Last Name*

Phone*
First Campers Date of Birth*
First Campers Information

COVID Release, continued


● I affirm that Participant, as well as all household members, have not traveled outside of the country, or to any city considered to be a "hot spot" for COVID-19 infections WITHIN THE PAST 30 days, and if so, the Participant of household members have traveled to the following locations on the following dates:

If participant has received a COVID-19 vaccination, please provide the following information below: 

  • Date of Vaccination
  • Type of Vaccination (i.e. Moderna, Pfizer, Johnson and Johnson) 
  • If you received Moderna or Pfizer, the dates of each shot: 
  • First shot date & Second shot date

Keely's Camp request that athletes attending the camp that have been vaccinated provide a copy of their CDC Vaccination Record Card or other evidence of vaccination.


Date of Vaccination:
Type of Vaccination (i.e. Moderna, Pfizer, Johnson and Johnson)

 If you received Moderna or Pfizer, the dates of each shot:


First shot date:

Second shot date:
First Campers Signature*
Second Campers Name

First Name*

Last Name*
Second Campers Date of Birth*
Second Campers Information

COVID Release, continued


● I affirm that Participant, as well as all household members, have not traveled outside of the country, or to any city considered to be a "hot spot" for COVID-19 infections WITHIN THE PAST 30 days, and if so, the Participant of household members have traveled to the following locations on the following dates:

If participant has received a COVID-19 vaccination, please provide the following information below: 

  • Date of Vaccination
  • Type of Vaccination (i.e. Moderna, Pfizer, Johnson and Johnson) 
  • If you received Moderna or Pfizer, the dates of each shot: 
  • First shot date & Second shot date

Keely's Camp request that athletes attending the camp that have been vaccinated provide a copy of their CDC Vaccination Record Card or other evidence of vaccination.


Date of Vaccination:
Type of Vaccination (i.e. Moderna, Pfizer, Johnson and Johnson)

 If you received Moderna or Pfizer, the dates of each shot:


First shot date:

Second shot date:
Third Campers Name

First Name*

Last Name*
Third Campers Date of Birth*
Third Campers Information

COVID Release, continued


● I affirm that Participant, as well as all household members, have not traveled outside of the country, or to any city considered to be a "hot spot" for COVID-19 infections WITHIN THE PAST 30 days, and if so, the Participant of household members have traveled to the following locations on the following dates:

If participant has received a COVID-19 vaccination, please provide the following information below: 

  • Date of Vaccination
  • Type of Vaccination (i.e. Moderna, Pfizer, Johnson and Johnson) 
  • If you received Moderna or Pfizer, the dates of each shot: 
  • First shot date & Second shot date

Keely's Camp request that athletes attending the camp that have been vaccinated provide a copy of their CDC Vaccination Record Card or other evidence of vaccination.


Date of Vaccination:
Type of Vaccination (i.e. Moderna, Pfizer, Johnson and Johnson)

 If you received Moderna or Pfizer, the dates of each shot:


First shot date:

Second shot date:
Fourth Campers Name

First Name*

Last Name*
Fourth Campers Date of Birth*
Fourth Campers Information

COVID Release, continued


● I affirm that Participant, as well as all household members, have not traveled outside of the country, or to any city considered to be a "hot spot" for COVID-19 infections WITHIN THE PAST 30 days, and if so, the Participant of household members have traveled to the following locations on the following dates:

If participant has received a COVID-19 vaccination, please provide the following information below: 

  • Date of Vaccination
  • Type of Vaccination (i.e. Moderna, Pfizer, Johnson and Johnson) 
  • If you received Moderna or Pfizer, the dates of each shot: 
  • First shot date & Second shot date

Keely's Camp request that athletes attending the camp that have been vaccinated provide a copy of their CDC Vaccination Record Card or other evidence of vaccination.


Date of Vaccination:
Type of Vaccination (i.e. Moderna, Pfizer, Johnson and Johnson)

 If you received Moderna or Pfizer, the dates of each shot:


First shot date:

Second shot date:
Fifth Campers Name

First Name*

Last Name*
Fifth Campers Date of Birth*
Fifth Campers Information

COVID Release, continued


● I affirm that Participant, as well as all household members, have not traveled outside of the country, or to any city considered to be a "hot spot" for COVID-19 infections WITHIN THE PAST 30 days, and if so, the Participant of household members have traveled to the following locations on the following dates:

If participant has received a COVID-19 vaccination, please provide the following information below: 

  • Date of Vaccination
  • Type of Vaccination (i.e. Moderna, Pfizer, Johnson and Johnson) 
  • If you received Moderna or Pfizer, the dates of each shot: 
  • First shot date & Second shot date

Keely's Camp request that athletes attending the camp that have been vaccinated provide a copy of their CDC Vaccination Record Card or other evidence of vaccination.


Date of Vaccination:
Type of Vaccination (i.e. Moderna, Pfizer, Johnson and Johnson)

 If you received Moderna or Pfizer, the dates of each shot:


First shot date:

Second shot date:
Sixth Campers Name

First Name*

Last Name*
Sixth Campers Date of Birth*
Sixth Campers Information

COVID Release, continued


● I affirm that Participant, as well as all household members, have not traveled outside of the country, or to any city considered to be a "hot spot" for COVID-19 infections WITHIN THE PAST 30 days, and if so, the Participant of household members have traveled to the following locations on the following dates:

If participant has received a COVID-19 vaccination, please provide the following information below: 

  • Date of Vaccination
  • Type of Vaccination (i.e. Moderna, Pfizer, Johnson and Johnson) 
  • If you received Moderna or Pfizer, the dates of each shot: 
  • First shot date & Second shot date

Keely's Camp request that athletes attending the camp that have been vaccinated provide a copy of their CDC Vaccination Record Card or other evidence of vaccination.


Date of Vaccination:
Type of Vaccination (i.e. Moderna, Pfizer, Johnson and Johnson)

 If you received Moderna or Pfizer, the dates of each shot:


First shot date:

Second shot date:
Seventh Campers Name

First Name*

Last Name*
Seventh Campers Date of Birth*
Seventh Campers Information

COVID Release, continued


● I affirm that Participant, as well as all household members, have not traveled outside of the country, or to any city considered to be a "hot spot" for COVID-19 infections WITHIN THE PAST 30 days, and if so, the Participant of household members have traveled to the following locations on the following dates:

If participant has received a COVID-19 vaccination, please provide the following information below: 

  • Date of Vaccination
  • Type of Vaccination (i.e. Moderna, Pfizer, Johnson and Johnson) 
  • If you received Moderna or Pfizer, the dates of each shot: 
  • First shot date & Second shot date

Keely's Camp request that athletes attending the camp that have been vaccinated provide a copy of their CDC Vaccination Record Card or other evidence of vaccination.


Date of Vaccination:
Type of Vaccination (i.e. Moderna, Pfizer, Johnson and Johnson)

 If you received Moderna or Pfizer, the dates of each shot:


First shot date:

Second shot date:
Eighth Campers Name

First Name*

Last Name*
Eighth Campers Date of Birth*
Eighth Campers Information

COVID Release, continued


● I affirm that Participant, as well as all household members, have not traveled outside of the country, or to any city considered to be a "hot spot" for COVID-19 infections WITHIN THE PAST 30 days, and if so, the Participant of household members have traveled to the following locations on the following dates:

If participant has received a COVID-19 vaccination, please provide the following information below: 

  • Date of Vaccination
  • Type of Vaccination (i.e. Moderna, Pfizer, Johnson and Johnson) 
  • If you received Moderna or Pfizer, the dates of each shot: 
  • First shot date & Second shot date

Keely's Camp request that athletes attending the camp that have been vaccinated provide a copy of their CDC Vaccination Record Card or other evidence of vaccination.


Date of Vaccination:
Type of Vaccination (i.e. Moderna, Pfizer, Johnson and Johnson)

 If you received Moderna or Pfizer, the dates of each shot:


First shot date:

Second shot date:
Ninth Campers Name

First Name*

Last Name*
Ninth Campers Date of Birth*
Ninth Campers Information

COVID Release, continued


● I affirm that Participant, as well as all household members, have not traveled outside of the country, or to any city considered to be a "hot spot" for COVID-19 infections WITHIN THE PAST 30 days, and if so, the Participant of household members have traveled to the following locations on the following dates:

If participant has received a COVID-19 vaccination, please provide the following information below: 

  • Date of Vaccination
  • Type of Vaccination (i.e. Moderna, Pfizer, Johnson and Johnson) 
  • If you received Moderna or Pfizer, the dates of each shot: 
  • First shot date & Second shot date

Keely's Camp request that athletes attending the camp that have been vaccinated provide a copy of their CDC Vaccination Record Card or other evidence of vaccination.


Date of Vaccination:
Type of Vaccination (i.e. Moderna, Pfizer, Johnson and Johnson)

 If you received Moderna or Pfizer, the dates of each shot:


First shot date:

Second shot date:
Tenth Campers Name

First Name*

Last Name*
Tenth Campers Date of Birth*
Tenth Campers Information

COVID Release, continued


● I affirm that Participant, as well as all household members, have not traveled outside of the country, or to any city considered to be a "hot spot" for COVID-19 infections WITHIN THE PAST 30 days, and if so, the Participant of household members have traveled to the following locations on the following dates:

If participant has received a COVID-19 vaccination, please provide the following information below: 

  • Date of Vaccination
  • Type of Vaccination (i.e. Moderna, Pfizer, Johnson and Johnson) 
  • If you received Moderna or Pfizer, the dates of each shot: 
  • First shot date & Second shot date

Keely's Camp request that athletes attending the camp that have been vaccinated provide a copy of their CDC Vaccination Record Card or other evidence of vaccination.


Date of Vaccination:
Type of Vaccination (i.e. Moderna, Pfizer, Johnson and Johnson)

 If you received Moderna or Pfizer, the dates of each shot:


First shot date:

Second shot date:
Campers 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.
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Additional Contact Information

Name of Emergency Contact: *

Emergency Phone: *

Local Phone Contact: *

Name of Local Contact and relationship to Participant: *
In consideration of (“Minor”) being permitted by Keely’s Camp to participate in its activities and to use its equipment and facilities, I further agree to indemnify and hold harmless Keely’s Camp from any and all claims which are brought by or on behalf of Minor, and which are in any way connected with such use or participation by Minor.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information

COVID Release, continued


● I affirm that Participant, as well as all household members, have not traveled outside of the country, or to any city considered to be a "hot spot" for COVID-19 infections WITHIN THE PAST 30 days, and if so, the Participant of household members have traveled to the following locations on the following dates:

If participant has received a COVID-19 vaccination, please provide the following information below: 

  • Date of Vaccination
  • Type of Vaccination (i.e. Moderna, Pfizer, Johnson and Johnson) 
  • If you received Moderna or Pfizer, the dates of each shot: 
  • First shot date & Second shot date

Keely's Camp request that athletes attending the camp that have been vaccinated provide a copy of their CDC Vaccination Record Card or other evidence of vaccination.


Date of Vaccination:
Type of Vaccination (i.e. Moderna, Pfizer, Johnson and Johnson)

 If you received Moderna or Pfizer, the dates of each shot:


First shot date:

Second shot date:
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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