PARTICIPANT WAIVER FORM ACKNOWLEDGEMENT I expressly acknowledge that there are certain dangers, risks, illnesses and personal injuries inherent in participating in the YMCA’s programs, events, classes, and/or other activities, which may result from unavoidable accidents or injuries, athletic activities, sports programs/classes, the use of any equipment, exercise, or other activities or from my or my minor child(ren)’s or ward(s)’ physical condition. I understand that the YMCA and its employees, agents, counselors, teachers, trainers, representatives, successors and assigns assume no responsibility for loss, damage, illness or injury to person or property that I or my minor child(ren) or ward(s), if applicable, may sustain as a result of my or their physical condition or resulting from my or their participation in any activities, programs, events, classes, the use or non-use of any equipment, exercise, horseback riding, archery, field trips, waterfront and pool activities, canoeing/boating, campfires, hiking, high ropes and other challenge courses, or any other activities, classes, events, or programs at and/or sponsored by the YMCA. I expressly acknowledge, on behalf of myself and my minor child(ren) and ward(s), heirs and executors, that I voluntarily assume the sole risk for any and all dangers, illnesses and personal injuries that may result from my or my minor child(ren)’s or ward(s)’ participation in any events/activities/programs/classes while at the YMCA and/or sponsored by the YMCA. I also acknowledge that the YMCA often uses photographs, videotapes, television programs, motion pictures, tape recordings, or other similar media for promotional purposes. I hereby consent to the use of my and/or my minor child(ren)’s or ward(s)’ name(s) and/or likeness(es) in such materials to be exhibited and used for advertising, trade purposes, solicitation of patronage, promotional purposes, or other similar purposes, even if my and/or my minor child(ren)’s or ward(s)’ name(s) and/or likeness(es) are an integral part of such photograph, videotape, television program, motion picture, tape recording, or other similar media.Copy and paste the body of your waiver here. RELEASE
In consideration of the YMCA allowing me and/or my minor child(ren) or ward(s) to attend and/or participate in any programs, events, classes, or other activities at the YMCA and/or sponsored by the YMCA, I hereby, for myself, my minor child(ren) or ward(s), heirs, and executors, waive, release and forever discharge the YMCA and its employees, agents, counselors, teachers, trainers, representatives, successors and assigns, from and against any and all rights and claims for any loss, damage, illness or injuries to person or property sustained as a result of my attendance and/or participation in any such programs, events, classes, and other activities, whether or not such loss, damage or injury results from the negligence of the YMCA and its employees, agents, or representatives or from some other cause. My agreement to release the YMCA does not include any loss, damage or injury that results from the YMCA's gross negligence or willful, wanton, or reckless misconduct. I further waive any and all rights to inspect or approve the photograph, videotape, television program, motion picture, tape recording or other use of my and/or my minor child(ren)’s or ward(s)’ name(s) and/or likeness(es), including any written article, script, caption or other writing that may accompany such use of my and/or my minor child(ren)’s or ward(s)’ name(s) and/or likeness(es). I hereby, for myself, my minor child(ren) or ward(s), heirs, and executors, waive, release and forever discharge the YMCA and its employees, agents, counselors, teachers, trainers, representatives, successors and assigns, from and against any and all liability, claims, losses, costs, expenses or damages for libel, slander, invasion of privacy, conversion, defamation, appropriation of likeness or any other claim based on the use of my and/or my minor child(ren)’s or ward(s)’ name(s) and/or likeness(es) in any such materials.
INDEMNIFICATION I hereby represent and warrant to the YMCA that I have the authority to execute this Participant Waiver Form on behalf of myself and/or on behalf of my minor child(ren) or ward(s) as parent, guardian and/or next friend, if applicable. In the event of any misrepresentation or breach of the foregoing warranty by me, or in the event that I, my minor child(ren) or ward(s), or any other person nevertheless asserts any claim against the YMCA arising out of my or my minor child(ren)’s or ward(s)’ participation in any program, event, class or other activity as set forth herein, I agree to indemnify, hold harmless and defend the YMCA from and against any and all liability, claims, losses, costs, expenses or damages resulting therefrom, including, but not limited to, claims of loss, damage, illness or injury to person or property whether or not such loss, damage, illness or injury results from the negligence of the YMCA or from some other cause.
ACCEPTANCE I expressly acknowledge and agree to the terms and conditions set forth on this Participant Waiver Form. October 11, 2024
PERMISSION FOR MEDICAL CARE AND PAYMENT I give the YMCA of Metropolitan Washington permission for my child to be given cardiopulmonary resuscitation (CPR) and first aid treatment by a certified staff member of the YMCA of Metropolitan Washington. I also give permission for my child to be transported by ambulance or aid car to an emergency center for treatment. I authorize the YMCA of Metropolitan Washington to obtain immediate medical care and give consent to the hospitalization and performance of necessary diagnostic tests upon, the use of surgery on, and/or the administration of drugs to his/her child or ward if an emergency occurs when he/she cannot be located immediately. It is also understood that this agreement may only cover those situations which are true emergencies and only when he/she cannot be reached. I understand that the provider will take every effort to contact me and/or my designated emergency contacts. I/we will be responsible for payment of medical expenses. Medical treatment costs are covered by the medical insurance provider and policy I have listed on this form. I Agree
PARENTAL AGREEMENT - The YMCA agrees to notify the parent/guardian whenever the child becomes ill and the parent/guardian will arrange to have the child picked up as soon as possible if requested by the YMCA.
- The parent/guardian agrees to inform the YMCA within 24 hours or the next business day after his child or any members of the immediate household has developed a reportable communicable disease, as defined by the State Board of Health, except for life-threatening diseases which must be reported immediately.
- My child has permission to be transported by a YMCA vehicle and to participate in all YMCA program activities and related field trips.
- My child has permission to participate in YMCA swimming activities.
- The parent / guardian authorizes the application of sunscreen and / or insect repellent for his/her child by YMCA staff.
- I am aware that the parent handbook is available for review at https://www.ymcadc.org/summer-camp-registration-forms/ and understand that it is my responsibility to read and understand/be aware of ALL policies, and agree to all blanket permission forms and opt out requests, as outlined in the parent handbook.
I Agree
CANCELLATION POLICY I understand and agree that - A non-refundable deposit of $75 will be collected at time of enrollment. Families can pay for camp fees in full at time of enrollment; however, the $75 deposit is non-refundable should a family cancel.
- Cancellations within 6 weeks before camp date, families forfeit 25% of camp fees in addition to camp deposit.
- Cancellations within 4 weeks before camp date, families forfeit 50% of camp fees in addition to camp deposit.
- Cancellations within 3 weeks before start of camp week or after, families forfeit all camp fees.
- Families can request for a 100% credit to be applied on their YMCA Metropolitan Washington account for future enrollment at any YMCA Metropolitan Washington branch, including Youth Services or Membership (credits are valid for one year from date of cancellation and are non-refundable once issued as a credit to the family YMCA Membership account).
I Agree
YMCA MEMBERSHIP REQUIREMENT I understand that campers are required to have an active YMCA membership (or be part of an active YMCA family membership) and that there are different membership types available. Membership status must be active throughout camp on either the qualifying annual or month-to-month membership option. Financial assistance is available for families/campers in need. I Agree All information on this form is true and complete to the best of my knowledge. I understand and agree to the Emergency Medical Authorization and the six (6) Parental Agreements, and cancellation policy outlined above. October 11, 2024 |