Dance Palace Camp Waivers

Medical Waiver and Authorization (agreement is required for participation):

Child's Name*
Parent/Guardian Name:
Relationship to Camper:
Email*

Medical Release: This health history is correct and accurately reflects the known health status of the named camper. The camper described has permission to participate in all camp activities except as noted by me and/or an examining physician. I give permission to camp staff to provide routine health care; to administer prescribed or over-the-counter medications as described; and to provide or obtain emergency care and transportation for the camper if needed.

Medications: I understand that all prescription medications must be in their original containers, unexpired, and labeled with specific instructions, including the child’s name and dosage, and that any prescription medications must include the full pharmacy label.

Release/Pick-up: I understand the release policy as described and authorize The Dance Palace to release my child to the people/methods listed on this form. I, the parent/legal guardian of the named camper, have read, understood, and agree to the above. When dropping off/picking up my child, I agree to wear a face covering and bring my own pen.


*NOT REQUIRED SECTION - IF NOT SIGNED, CHILD DOES NOT HAVE PERMISSION*

I give permission for my child to walk and/or bike home.

Signature of Custodial Parent/Guardian:


Day Camp Agreement of Terms:

Program: I give permission for my child to participate in all camp program activities similar to those described on the website. I understand that Dance Palace Outdoor Summer Camp reserves the right to change program activities or instructors and cancel programs, should The Dance Palace decide in its sole judgment that it is necessary and appropriate to do so.

Expectations/Dismissal: I have informed the Camp Director and other appropriate Dance Palace Outdoor Summer Camp staff of any limitations to my child’s participation and agree to abide by The Dance Palace’s sole judgment as to whether my child can be accommodated in the camp program. I understand that failing to disclose any physical, emotional, or behavioral needs or conditions may result in the child’s dismissal from the program without refund. I understand that my child must follow the stated behavior expectations and safety rules and that Dance Palace Outdoor Summer Camp reserves the right in its sole judgment to dismiss without refund any child whose behavior interferes with the rights and safety of others or consistently disrupts group dynamics or activities.

Sun Care: I understand that outdoor exploration is an integral part of Dance Palace Outdoor Summer Camp programs and my child will be exposed to risks including but not limited to sun, ticks, and insects. I understand that it is my responsibility to apply sunscreen to my child before bringing them to camp each day.

Bug care: We know that there are ticks in our area. I understand that some ticks may transmit disease after being attached for over 24 hours, and it is my responsibility to check my child’s body thoroughly every day and to remove any ticks that may become attached. I am responsible to do a complete check upon my child’s return home. Hygiene Protocols: I understand that due to the COVID-19 virus and other communicable diseases that my child may use hand sanitizer with at least 60% alcohol when handwashing is not available.

Cancellation Policy: I understand that there are no refunds.

I, the parent/legal guardian of the named camper, have read, understood, and agree to the above.


Day Camp Audio/Visual Image Release:

Dance Palace Outdoor Summer Camp uses images and sounds of children and staff participating in Dance Palace Outdoor Summer Camp programs as a way of documenting the enjoyable and educational experiences they have while exploring the natural world. The Dance Palace will not identify my child, or will identify my child only by first name and program, unless I give prior written permission to do otherwise. In consideration of the above, I hereby give my permission and consent to The Dance Palace (1) photographing, filming, and video/audio taping my child, (2) using and displaying images and sounds of my child in The Dance Palace’s websites, archives, and promotional or informational material, including, but not limited to, newsletters (written and virtual), brochures, advertisements, and newspaper articles, social media, and I hereby waive and release on behalf of my child and myself any rights to compensation for, or ownership of, such images and/or sounds of my child and the above uses of them by The Dance Palace.

I have read this audio/visual image release and agree to its terms and conditions.


Assumption of the Risk and Waiver of Liability

Please read carefully. You will be sent, and required to sign, a physical copy of this release and return it to the Dance Palace for your child to participate.

  • As parent or legal guardian, I give permission for my child to attend Dance Palace Outdoor Summer Camp.
  • I have read the information and policies and understand it is my part of my registration agreement. I agree to comply with the virtual camp policies.
  • I agree to release and hold harmless the Dance Palace, its employees, officers, directors, agents, and contractors from all liability for any personal injury, property damage, loss, insurance costs, and all liability incurred as a result of my child’s participation in camp. These terms serve as a release for myself and members of my family.
  • I give the Dance Palace permission to use my email address as part of a group list (sent by blind copy) to receive information about camp activities and relevant information.

Consent for Minors
I am the legal custodial parent or legal guardian of the above-named minor, and I hereby authorize and permit said minor to participate in Dance Palace Outdoor Summer Camp and in all activities, events, and programs that are part of or are associated with the camp (collectively “Camp”). I have read material on the website about this program.

Acknowledgement and Waiver
Although we will do our best to supervise, we know that kids get hurt. I realize that participation in the Camp entails certain risks of personal injury and property damage. I affirm and agree that I and any above-named minor(s) are participating in the Camp voluntarily and knowingly assume all such risks. In consideration of me and/or any above-named minor(s) being allowed to participate in the Camp, I hereby, on behalf of myself, any above-named minor(s), and our respective assigns, beneficiaries, heirs, personal representatives, trustees, and other successors or representatives, voluntarily and forever release, waive, and discharge The Dance Palace, and their respective employees, volunteers and representatives, from and against, and hereby covenant not to sue any of them regarding, any and all causes of action, claims, damages, injuries, liabilities, or losses (including, without limitation, such that may in any way arise from, be connected with, or relate in any way to the Camp or the negligence of The Dance Palace, or any of their respective employees or representatives) arising out of or in any way resulting from the Camp or our participation in or involvement with the Camp or any related activities or programs. In return for sufficient good and valuable consideration, I hereby indemnify, hold harmless, and defend The Dance Palace from and against any and all causes of action, claims, damages, injuries, liabilities, or losses that in any way arise out of, are connected with, or result from my or any above-named minor(s) participation in or involvement with the Camp or any related activities or programs. Such indemnification and hold harmless terms shall apply and be fully enforceable even if such injury or damage arises out of the negligence of The Dance Palace, or any of their respective directors, employees, officers, agents, or representatives and shall include, without limitation, The Dance Palace’s reasonable attorney’s fees associated therewith.

I, on behalf of myself and any above-named minor(s) and our respective assigns, beneficiaries, heirs, successors, and other representatives, agree that the waiver and release, assumption of risk, and indemnification, hold harmless, and defense provisions stated herein are intended to be as broad and inclusive as is permitted by the laws of the State of California and that if any portion thereof is held invalid, the balance shall, notwithstanding such invalidity of any portion, continue in full force and effect.

I have read this document, fully understand its terms, and understand that I, on behalf of myself and any above named minor(s), am through this document giving up substantial rights, including, among others, the right to sue and undertaking substantial obligations, including, among others, indemnification.

I acknowledge that I am agreeing hereto freely and voluntarily and intend this acknowledgement (whether hard copy or electronically transmitted) to be a complete and unconditional release of liability.

Signing below confirms that you have read the camp information on the website, above permission statements, that you understand it, and that you agree to be bound by it.

Assumption of the Risk and Waiver of Liability Relating to COVID-19

PLEASE READ CAREFULLY

The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. As a result, federal, state and local governments and health agencies recommend social distancing, mask wearing, and sanitizing. Dance Palace Outdoor Summer Camp has put in place preventative measures to reduce the spread of COVID-19 at its day camp; however, Dance Palace Outdoor Summer Camp cannot guarantee that you or your child(ren) will not become infected with COVID-19. I understand that this Assumption of the Risk and Waiver of Liability agreement is in addition to, and is not a substitute for, any other documentation or registration information that I might be required to execute by The Dance Palace in order to enroll my child(ren) in the Dance Palace Outdoor Summer Camp. By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren) and I may be exposed to or infected by COVID-19 by attending the day camp or similar activity and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at the day camp or similar activity may result from the actions, omissions, or negligence of myself and others, including, but not limited to, The Dance Palace, including employees and volunteers, and program participants and their families. I VOLUNTARILY AGREE TO ASSUME ALL OF THE FOREGOING RISKS AND ACCEPT SOLE RESPONSIBILITY FOR ANY INJURY TO MY CHILD(REN) OR MYSELF (INCLUDING, BUT NOT LIMITED TO, PERSONAL INJURY, DISABILITY, AND DEATH), ILLNESS, DAMAGE, LOSS, CLAIM, LIABILITY, OR EXPENSE, OF ANY KIND, THAT I OR MY CHILD(REN) MAY EXPERIENCE OR INCUR IN CONNECTION WITH MY CHILD(REN)’S ATTENDANCE AT THE DANCE PALACE OUTDOOR DAY CAMP OR PARTICIPATION IN DANCE PALACE PROGRAMMING (“CLAIMS”). ON MY BEHALF, AND ON BEHALF OF MY CHILDREN, I HEREBY RELEASE, COVENANT NOT TO SUE, DISCHARGE, AND HOLD HARMLESS THE DANCE PALACE BOARD OF DIRECTORS, EMPLOYEES, AGENTS, AND REPRESENTATIVES, OF AND FROM THE 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 Dance Palace staff, board of directors, Dance Palace Outdoor Summer Camp employees, volunteers, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in Dance Palace Outdoor Summer Camp or similar program.

Full Names of Participants in Dance Palace Outdoor Summer Camp:


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