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PO Box 303

June Lake CA 93529

760-428-9512 

info@sierrastem.org

Sierra STEM Program Participant Behavioral Contract 

Sierra STEM camps are fun, inclusive spaces for everyone to learn and grow. In order for this to be the the best program it can be, we ask that all kids joining us are committed to four goals:

  • Participate with Respect 
  • Listen to Everyone 
  • Act with Kindness 
  • Practice Safety  

What participants can expect from Sierra STEM instructors

Sierra STEM instructors are great humans! They’re full of kindness, expertise, professionalism, and positivity. They treat everyone with respect, practice active learning and clear communication, and they help lift up everyone around them. 


What Sierra STEM expects of participants 

  • Participate with Respect: take part in discussions, activities, and chores; show respect and courtesy for other participants, instructors, and the communities we travel through (both human & ecological). 
  • Listen to Everyone: when others are speaking, stay quiet and give them your attention; follow directions given by instructors; pay attention to your fellow students and the things they are communicating to you. 
  • Act with Kindness: treat others the way you would like to be treated; remember that everyone has different experiences, and together we are a community that cares for each other. 
  • Practice Safety: follow guidelines for activities, act responsibly, and avoid reckless behavior that could endanger or harm myself, others, or the environment. 

What if things go wrong? 

Cooperation, teamwork, and good communication are cornerstones of all our practices and programs, and we also expect that occasionally there will be conflicts to resolve and disagreements to work through. We address disagreements directly by facilitating a conversation and guiding toward mutual conflict resolution.  


In the case of an irresolvable conflict, frequent behavioral issues, or when serious harm has been done, a student may be expelled from a Sierra STEM program. Sierra STEM staff retain the ultimate decision regarding whether someone’s presence with the Program is harming the safety or experience of others, and we reserve the right to remove someone from a Program as deemed necessary. 


My child and I understand these behavior expectations and are committed to upholding them. 



Participant Agreement, Liability Waiver, and Assumption of Risk

In consideration of my participation in programs facilitated by Sierra STEM and the services provided by Sierra STEM, its agents, owners, officers, volunteers, participants, employees, and all other persons or entities acting in any capacity on their behalf (hereinafter collectively referred to as “Sierra STEM”), I hereby agree to release, indemnify, and discharge Sierra STEM, on behalf of myself, my spouse, my children, my parents, my heirs, assigns, personal representatives, and estate as follows:

I understand and willingly agree that my participation in this program facilitated by Sierra STEM is undertaken with full understanding and appreciation for the risks and that I undertake participation solely at my own request and risk. My participation in this activity is purely voluntary; no one is forcing me to participate and I elect to participate in spite of and with full knowledge of the inherent risks, as described below.

The activities in any Sierra STEM program depend on the program in which I (or my child) is enrolled. I understand and accept that there are inherent risks associated with outdoor or outdoor skill-building activities, which can include, but are not limited to: hot or cold weather injuries or illnesses; injuries from natural disasters like storms or earthquakes; drowning; falling or tripping on snow, ice, or rocks; injuries from obstacles hidden by snow or ice; injuries related to climbing or falling on rocks, like broken bones or death; injuries related to hiking, like blisters or bruises; injuries from falling like concussions; injuries or illnesses related to altitude; injuries caused by the failure or malfunction or misuse of equipment; injuries from manmade objects or equipment; illnesses related to preparation or consumption of food; injuries related to vehicle travel; and contagious illnesses.

I understand that there is a risk of becoming lost or separated from companions or program facilitators/chaperones; that accidents, illnesses, or injuries may occur in remote places where medical facilities are not readily accessible; that the description of these risks is not complete and that unknown or unanticipated risks may result in injury, illness, disability, or death, and that Sierra STEM staff may not give complete warnings for every activity or risk; the proper use and wearing of safety equipment can greatly reduce the risk of injury. I agree to wear and/or use appropriate safety equipment as directed by law or by Sierra STEM; that this activity may be physically strenuous and requires a certain level of physical fitness.

I agree to use all provided equipment and supplies as intended and as directed, and I may be held responsible for the repair or replacement of any equipment, supplies, or facilities that are lost or damaged as a result of my participation in this program. I verify that, if my health changes between completion of the health questionnaire and the beginning of the Sierra STEM program, I will inform Sierra STEM of these changes. I certify that I have adequate insurance to cover any injury or damage I may cause or suffer while participating in this program, or agree to bear such costs myself.

I hereby release, indemnify (meaning to pay or reimburse for expenses), and hold harmless, Sierra STEM from any and all claims, demands, losses, and liability related to any injury, illness, property damage, disability, or death, I, my child, or any other person may cause or suffer related to my (or my child’s) participation in the program or the use of any equipment or facilities. This release and indemnity includes any claims related to the negligence of Sierra STEM and is to be interpreted to the fullest extent allowed by law. I fully acknowledge and assume both the inherent risk and responsibility for claims caused by my (or my child’s) negligent acts and omissions. I consent to the use of any photographs or video taken of me (or my child) or provided by me (or my child) to be used for publicity, promotion, television, websites, or any other use, and expressly waive any right of privacy, compensation, copyright, or other ownership right connected to this use. I agree that any dispute I have (or my child has) with Sierra STEM will be governed by the laws of the state of California and that any suit, arbitration, mediation, or other claims must be brought only in the state of California. If any portion of this agreement is deemed unenforceable, the remaining parts of the agreement will continue to remain in full force and effect. 

By signing this document, I acknowledge and agree that I understand the potential risks associated with participation in the activity offered or organized by Sierra STEM and voluntarily accept them. I acknowledge that if anyone is hurt or property is damaged during my participation in this activity, I may be found by a court of law to have waived my right to maintain a lawsuit against Sierra STEM on the basis of any claim from which I have released them herein. I have had sufficient opportunity to read this entire document. I have read and understood it, and I agree to be bound by its terms.




Participant Image and Likeness Release

I agree to release any images of myself/participant by means of photography or videography while I am a participant in any of Sierra STEM’s programs or while I am a client of Sierra STEM. Sierra STEM may use the above-mentioned images without limitation in connection with any brochure, website, social media, publicity, marketing, or educational materials.

I understand that Sierra STEM reserves the right to use the name of the Partner Organization and/or the Program in which you are participating, along with any participant's first name and last initial in conjunction with any of the above-mentioned images.

I release Sierra STEM from any claims whatsoever which arise in said regard.






First Participant's Name
First Name*
Middle Name
Last Name*
Phone*
First Participant's Date of Birth*
Date of Birth
First Participant's Health Information
Does your child have any food allergies or dietary restrictions? *
No
Yes
If yes, please list the allergen and the reaction in the box above.
Other than foods, do you have allergies/reactions to any of the following (check all that apply):
Medications
Insects
Plants
Other
Please provide details about any allergies/reactions you indicated above.
Do any of your allergies require that you carry an Epi Pen with you? *
No
Yes
Do you currently have any of the following conditions (check all that apply):
Asthma
Diabetes
Epilepsy
Heart condition
If yes to any of the above medical conditions, please explain/describe:
Do you have a history of any of the following conditions? (Check all that apply.)
High blood pressure
Heart palpitations
Chest pain or pressure
Heart attack
Heart disease
Heart murmur
Stroke
Seizure
Vasovagal syncope or other fainting episodes
Medical implants or devices of any kind
If yes to any of the above medical conditions, please explain/describe:
First Participant's Signature*
Second Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Second Participant's Health Information
Does your child have any food allergies or dietary restrictions? *
No
Yes
If yes, please list the allergen and the reaction in the box above.
Other than foods, do you have allergies/reactions to any of the following (check all that apply):
Medications
Insects
Plants
Other
Please provide details about any allergies/reactions you indicated above.
Do any of your allergies require that you carry an Epi Pen with you? *
No
Yes
Do you currently have any of the following conditions (check all that apply):
Asthma
Diabetes
Epilepsy
Heart condition
If yes to any of the above medical conditions, please explain/describe:
Do you have a history of any of the following conditions? (Check all that apply.)
High blood pressure
Heart palpitations
Chest pain or pressure
Heart attack
Heart disease
Heart murmur
Stroke
Seizure
Vasovagal syncope or other fainting episodes
Medical implants or devices of any kind
If yes to any of the above medical conditions, please explain/describe:
Third Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Third Participant's Health Information
Does your child have any food allergies or dietary restrictions? *
No
Yes
If yes, please list the allergen and the reaction in the box above.
Other than foods, do you have allergies/reactions to any of the following (check all that apply):
Medications
Insects
Plants
Other
Please provide details about any allergies/reactions you indicated above.
Do any of your allergies require that you carry an Epi Pen with you? *
No
Yes
Do you currently have any of the following conditions (check all that apply):
Asthma
Diabetes
Epilepsy
Heart condition
If yes to any of the above medical conditions, please explain/describe:
Do you have a history of any of the following conditions? (Check all that apply.)
High blood pressure
Heart palpitations
Chest pain or pressure
Heart attack
Heart disease
Heart murmur
Stroke
Seizure
Vasovagal syncope or other fainting episodes
Medical implants or devices of any kind
If yes to any of the above medical conditions, please explain/describe:
Fourth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Fourth Participant's Health Information
Does your child have any food allergies or dietary restrictions? *
No
Yes
If yes, please list the allergen and the reaction in the box above.
Other than foods, do you have allergies/reactions to any of the following (check all that apply):
Medications
Insects
Plants
Other
Please provide details about any allergies/reactions you indicated above.
Do any of your allergies require that you carry an Epi Pen with you? *
No
Yes
Do you currently have any of the following conditions (check all that apply):
Asthma
Diabetes
Epilepsy
Heart condition
If yes to any of the above medical conditions, please explain/describe:
Do you have a history of any of the following conditions? (Check all that apply.)
High blood pressure
Heart palpitations
Chest pain or pressure
Heart attack
Heart disease
Heart murmur
Stroke
Seizure
Vasovagal syncope or other fainting episodes
Medical implants or devices of any kind
If yes to any of the above medical conditions, please explain/describe:
Fifth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Fifth Participant's Health Information
Does your child have any food allergies or dietary restrictions? *
No
Yes
If yes, please list the allergen and the reaction in the box above.
Other than foods, do you have allergies/reactions to any of the following (check all that apply):
Medications
Insects
Plants
Other
Please provide details about any allergies/reactions you indicated above.
Do any of your allergies require that you carry an Epi Pen with you? *
No
Yes
Do you currently have any of the following conditions (check all that apply):
Asthma
Diabetes
Epilepsy
Heart condition
If yes to any of the above medical conditions, please explain/describe:
Do you have a history of any of the following conditions? (Check all that apply.)
High blood pressure
Heart palpitations
Chest pain or pressure
Heart attack
Heart disease
Heart murmur
Stroke
Seizure
Vasovagal syncope or other fainting episodes
Medical implants or devices of any kind
If yes to any of the above medical conditions, please explain/describe:
Sixth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Sixth Participant's Health Information
Does your child have any food allergies or dietary restrictions? *
No
Yes
If yes, please list the allergen and the reaction in the box above.
Other than foods, do you have allergies/reactions to any of the following (check all that apply):
Medications
Insects
Plants
Other
Please provide details about any allergies/reactions you indicated above.
Do any of your allergies require that you carry an Epi Pen with you? *
No
Yes
Do you currently have any of the following conditions (check all that apply):
Asthma
Diabetes
Epilepsy
Heart condition
If yes to any of the above medical conditions, please explain/describe:
Do you have a history of any of the following conditions? (Check all that apply.)
High blood pressure
Heart palpitations
Chest pain or pressure
Heart attack
Heart disease
Heart murmur
Stroke
Seizure
Vasovagal syncope or other fainting episodes
Medical implants or devices of any kind
If yes to any of the above medical conditions, please explain/describe:
Seventh Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Seventh Participant's Health Information
Does your child have any food allergies or dietary restrictions? *
No
Yes
If yes, please list the allergen and the reaction in the box above.
Other than foods, do you have allergies/reactions to any of the following (check all that apply):
Medications
Insects
Plants
Other
Please provide details about any allergies/reactions you indicated above.
Do any of your allergies require that you carry an Epi Pen with you? *
No
Yes
Do you currently have any of the following conditions (check all that apply):
Asthma
Diabetes
Epilepsy
Heart condition
If yes to any of the above medical conditions, please explain/describe:
Do you have a history of any of the following conditions? (Check all that apply.)
High blood pressure
Heart palpitations
Chest pain or pressure
Heart attack
Heart disease
Heart murmur
Stroke
Seizure
Vasovagal syncope or other fainting episodes
Medical implants or devices of any kind
If yes to any of the above medical conditions, please explain/describe:
Eighth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Eighth Participant's Health Information
Does your child have any food allergies or dietary restrictions? *
No
Yes
If yes, please list the allergen and the reaction in the box above.
Other than foods, do you have allergies/reactions to any of the following (check all that apply):
Medications
Insects
Plants
Other
Please provide details about any allergies/reactions you indicated above.
Do any of your allergies require that you carry an Epi Pen with you? *
No
Yes
Do you currently have any of the following conditions (check all that apply):
Asthma
Diabetes
Epilepsy
Heart condition
If yes to any of the above medical conditions, please explain/describe:
Do you have a history of any of the following conditions? (Check all that apply.)
High blood pressure
Heart palpitations
Chest pain or pressure
Heart attack
Heart disease
Heart murmur
Stroke
Seizure
Vasovagal syncope or other fainting episodes
Medical implants or devices of any kind
If yes to any of the above medical conditions, please explain/describe:
Ninth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Ninth Participant's Health Information
Does your child have any food allergies or dietary restrictions? *
No
Yes
If yes, please list the allergen and the reaction in the box above.
Other than foods, do you have allergies/reactions to any of the following (check all that apply):
Medications
Insects
Plants
Other
Please provide details about any allergies/reactions you indicated above.
Do any of your allergies require that you carry an Epi Pen with you? *
No
Yes
Do you currently have any of the following conditions (check all that apply):
Asthma
Diabetes
Epilepsy
Heart condition
If yes to any of the above medical conditions, please explain/describe:
Do you have a history of any of the following conditions? (Check all that apply.)
High blood pressure
Heart palpitations
Chest pain or pressure
Heart attack
Heart disease
Heart murmur
Stroke
Seizure
Vasovagal syncope or other fainting episodes
Medical implants or devices of any kind
If yes to any of the above medical conditions, please explain/describe:
Tenth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Tenth Participant's Health Information
Does your child have any food allergies or dietary restrictions? *
No
Yes
If yes, please list the allergen and the reaction in the box above.
Other than foods, do you have allergies/reactions to any of the following (check all that apply):
Medications
Insects
Plants
Other
Please provide details about any allergies/reactions you indicated above.
Do any of your allergies require that you carry an Epi Pen with you? *
No
Yes
Do you currently have any of the following conditions (check all that apply):
Asthma
Diabetes
Epilepsy
Heart condition
If yes to any of the above medical conditions, please explain/describe:
Do you have a history of any of the following conditions? (Check all that apply.)
High blood pressure
Heart palpitations
Chest pain or pressure
Heart attack
Heart disease
Heart murmur
Stroke
Seizure
Vasovagal syncope or other fainting episodes
Medical implants or devices of any kind
If yes to any of the above medical conditions, please explain/describe:
Emergency Contact
First Name*
Last Name*
Emergency Contact's Phone Number*
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*
Relationship*
Phone*
Parent or Guardian's Date of Birth*
Date of Birth
Parent or Guardian's Health Information
Does your child have any food allergies or dietary restrictions? *
No
Yes
If yes, please list the allergen and the reaction in the box above.
Other than foods, do you have allergies/reactions to any of the following (check all that apply):
Medications
Insects
Plants
Other
Please provide details about any allergies/reactions you indicated above.
Do any of your allergies require that you carry an Epi Pen with you? *
No
Yes
Do you currently have any of the following conditions (check all that apply):
Asthma
Diabetes
Epilepsy
Heart condition
If yes to any of the above medical conditions, please explain/describe:
Do you have a history of any of the following conditions? (Check all that apply.)
High blood pressure
Heart palpitations
Chest pain or pressure
Heart attack
Heart disease
Heart murmur
Stroke
Seizure
Vasovagal syncope or other fainting episodes
Medical implants or devices of any kind
If yes to any of the above medical conditions, please explain/describe:
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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