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COVID-19 Compliance, Liability Waiver, and Assumption of the Risk

WARNING: THIS RELEASE IS LEGALLY BINDING. IF YOU ARE FILLING THIS OUT FOR A MINOR OR MINORS, YOU MUST BE THEIR PARENT OR LEGAL GUARDIAN. PLEASE READ CAREFULLY BEFORE SIGNING.

I understand that Salt Pump has put in place safety rules and precautions in order to mitigate  the spread of COVID-19, which rules and precautions may be updated at any time and that they  are committed to complying with any applicable CDC or State of Maine rules. While  acknowledging that these rules and precautions may or may not be effective in mitigating the  spread of COVID-19, I agree to comply and to require my child(ren) to comply with such rules and  precautions which may include, but are not limited to, mask wearing, hand washing, hand  sanitizing, and social distancing. I understand that failing to comply could result in my child(ren)  being excluded from Salt Pump Kids Summer Camp programming.

I agree that if my child(ren) or anyone in my immediate household is exhibiting symptoms of  acute respiratory illness, a fever of 100.4ºF or higher, or signs of a fever, I will keep my children  away from the Salt Pump Kids Summer Camp programming until a health care provider has  released the impacted individual(s) from quarantine. In the event applicable laws, orders or  regulations of the State of Maine or Salt Pump rules require me, my child(ren) or someone in my  household to stay away from the Salt Pump because of symptoms or exposure to someone who  has COVID-19 symptoms or has tested positive, or I otherwise determine based on my own  judgment or that of a medical professional to stay away, I will notify Tino Fiumara ( at info@saltpumpclimbing.com), and will not return my child to Salt Pump and Salt Pump Kids  Summer Camp until released by a health care provider and approved by Salt Pump.

By signing this agreement, I acknowledge the contagious nature of COVID-19, the fact that it can  be difficult to identify in another, and the inherent risks of exposure at Salt Pump to those who  may be infected with COVID-19. I voluntarily assume the risk that I or my child(ren) may be  exposed to or infected by COVID- 19 by attending Salt Pump Kids Summer Camp or entering Salt  Pump’s facilities and that such exposure or infection may result in personal injury, illness,  permanent disability, and/or even death.

I voluntarily assume full responsibility for any and all risks of illness or injury associated with my  and/or my children’s exposure to COVID-19. On my behalf, and on behalf of my children, I  completely absolve Salt Pump, their affiliates, and its and their officers, employees, agents,  contractors, volunteers, and representatives of any and all legal or financial responsibility, including, but not limited to, any personal injury, disability, illness, damage or death from  exposure to COVID-19, whether such exposure occurs before, during or after my child(ren)'s attendance at Salt Pump or participation in Salt Pump programming (“Claims”). On my behalf,  and on behalf of my children, I hereby release, covenant not to sue, discharge, and hold harmless  Salt Pump, its employees, agents, and representatives, of and from any Claims, including 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 Salt Pump, its employees, agents, and representatives, whether a COVID-19  infection occurs before, during, or after participation in any Salt Pump program.

I HAVE READ AND UNDERSTAND THIS AGREEMENT AND I AM AWARE THAT BY SIGNING THIS  AGREEMENT I MAY BE WAIVING CERTAIN LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE ON MY  OWN BEHALF AND THE BEHALF OF MY CHILD(REN). THIS AGREEMENT SHALL BE BINDING UPON  ME AND MY CHILD(REN), HEIRS, LEGAL REPRESENTATIVES, AND ASSIGNS, AND SHALL INURE TO  THE BENEFIT OF SALT PUMP, ITS AFFILIATES, AND ITS AND THEIR SUCCESSORS AND ASSIGNS.

 

October 9, 2024

First Camper Name

First Name*

Middle Name

Last Name*
First Camper Date of Birth*
First Camper Signature*
Second Camper Name

First Name*

Middle Name

Last Name*
Second Camper Date of Birth*
Third Camper Name

First Name*

Middle Name

Last Name*
Third Camper Date of Birth*
Fourth Camper Name

First Name*

Middle Name

Last Name*
Fourth Camper Date of Birth*
Fifth Camper Name

First Name*

Middle Name

Last Name*
Fifth Camper Date of Birth*
Sixth Camper Name

First Name*

Middle Name

Last Name*
Sixth Camper Date of Birth*
Seventh Camper Name

First Name*

Middle Name

Last Name*
Seventh Camper Date of Birth*
Eighth Camper Name

First Name*

Middle Name

Last Name*
Eighth Camper Date of Birth*
Ninth Camper Name

First Name*

Middle Name

Last Name*
Ninth Camper Date of Birth*
Tenth Camper Name

First Name*

Middle Name

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

Email*

Confirm Email*
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*

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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