Social Skills Summer Camp Registration Forms HOUSEHOLD INFORMATION FORMComplete this form once for your household Complete Household Information Form Household Information Name * First Name Last Name Email * Phone * Best number to use to reach you during Camp hours 10:00am-2:30pm. (###) ### #### Additional Contact * Please provide contact information for 2 additional individuals. Can be parent not listed above, child care provider, family member, friend of family. This person must be able to respond to an emergency including coming to pick up child from Social Skills Summer Camp. First Name Last Name Phone * (###) ### #### Authorized to drop off /pick up * This contact is authorized to: Drop Off Pick Up Additional Contact * First Name Last Name Phone * (###) ### #### Authorized to drop off/pick up * Drop Off Pick Up Thank you! SOCIAL SKILLS SUMMER CAMP LIABILITY WAIVERSComplete this form once for your household (will apply to all participants linked to your household) Complete Social Skills Summer Camp Liability Waivers Social Skills Summer Camp Liability Waivers Waiver and Release of Liability IN CONSIDERATION OF the risk of injury that exists while participating in SOCIAL SKILLS SUMMER CAMP (PROGRAM OFFERED THROUGH ERIN BENNETTS LLC) (hereinafter the "Activity"); and IN CONSIDERATION OF my desire to participate in said Activity and being given the right to participate in same; I HEREBY, for myself, my heirs, executors, administrators, assigns, or personal representatives (hereinafter collectively, "Releasor," "I" or "me", which terms shall also include Releasor's parents or guardian if Releasor is under 18 years of age), knowingly and voluntarily enter into this WAIVER AND RELEASE OF LIABILITY and hereby waive any and all rights, claims or causes of action of any kind arising out of my participation in the Activity I HEREBY release and forever discharge ERIN BENNETTS (OWNER OF ERIN BENNETTS LLC), located at 8 W Dry Creek Cir Ste 120, Littleton, Colorado 80120, their affiliates, managers, members, agents, attorneys, staff, volunteers, heirs, representatives, predecessors, successors and assigns (collectively "Releasees"), from any physical or psychological injury that I may suffer as a direct result of my participation in the aforementioned Activity. I AM VOLUNTARILY PARTICIPATING IN THE AFOREMENTIONED ACTIVITY AND I AM PARTICIPATING IN THE ACTIVITY ENTIRELY AT MY OWN RISK. I AM AWARE OF THE RISKS ASSOCIATED WITH PARTICIPATING IN THIS ACTIVITY, WHICH MAY INCLUDE, BUT ARE NOT LIMITED TO: PHYSICAL OR PSYCHOLOGICAL INJURY, PAIN, SUFFERING, ILLNESS, DISFIGUREMENT, TEMPORARY OR PERMANENT DISABILITY (INCLUDING PARALYSIS), ECONOMIC OR EMOTIONAL LOSS, AND DEATH. I UNDERSTAND THAT THESE INJURIES OR OUTCOMES MAY ARISE FROM MY OWN OR OTHERS' NEGLIGENCE, CONDITIONS RELATED TO TRAVEL TO AND FROM THE ACTIVITY, OR FROM CONDITIONS AT THE ACTIVITY LOCATION(S). NONETHELESS, I ASSUME ALL RELATED RISKS, BOTH KNOWN AND UNKNOWN TO ME, OF MY PARTICIPATION IN THIS ACTIVITY. I FURTHER AGREE to indemnify, defend and hold harmless the Releasees against any and all claims, suits or actions of any kind whatsoever for liability, damages, compensation or otherwise brought by me or anyone on my behalf, including attorney's fees and any related costs. I FURTHER ACKNOWLEDGE that Releasees are not responsible for errors, omissions, acts or failures to act of any party or entity conducting a specific event or activity on behalf of Releasees. In the event that I should require medical care or treatment, I authorize Erin Bennetts (Owner of Erin Bennetts LLC) to provide all emergency medical care deemed necessary, including but not limited to, first aid, CPR, the use of AEDs, emergency medical transport, and sharing of medical information with medical personnel. I further agree to assume all costs involved and agree to be financially responsible for any costs incurred as a result of such treatment. I am aware and understand that I should carry my own health insurance. I FURTHER ACKNOWLEDGE that this Activity may involve a test of a person's physical and mental limits and may carry with it the potential for death, serious injury, and property loss. I agree not to participate in the Activity unless I am medically able and properly trained, and I agree to abide by the decision of the Erin Bennetts (Owner of Erin Bennetts LLC) official or agent, regarding my approval to participate in the Activity. I HEREBY ACKNOWLEDGE THAT I HAVE CAREFULLY READ THIS "WAIVER AND RELEASE" AND FULLY UNDERSTAND THAT IT IS A RELEASE OF LIABILITY. I EXPRESSLY AGREE TO RELEASE AND DISCHARGE Erin Bennetts (Owner of Erin Bennetts LLC)AND ALL OF ITS AFFILIATES, MANAGERS, MEMBERS, AGENTS, ATTORNEYS, STAFF, VOLUNTEERS, HEIRS, REPRESENTATIVES, PREDECESSORS, SUCCESSORS AND ASSIGNS, FROM ANY AND ALL CLAIMS OR CAUSES OF ACTION AND I AGREE TO VOLUNTARILY GIVE UP OR WAIVE ANY RIGHT THAT I OTHERWISE HAVE TO BRING A LEGAL ACTION AGAINST Erin Bennetts (Owner of Erin Bennetts LLC) FOR PERSONAL INJURY OR PROPERTY DAMAGE. To the extent that statute or case law does not prohibit releases for ordinary negligence, this release is also for such negligence on the part of Erin Bennetts (Owner of Erin Bennetts LLC), its agents, and employees. I agree that this Release shall be governed for all purposes by Colorado law, without regard to any conflict of law principles. This Release supersedes any and all previous oral or written promises or other agreements. In the event that any damage to equipment or facilities occurs as a result of my or my family's or my agent's willful actions, neglect or recklessness, I acknowledge and agree to be held liable for any and all costs associated with any such actions of neglect or recklessness. THIS WAIVER AND RELEASE OF LIABILITY SHALL REMAIN IN EFFECT FOR THE DURATION OF MY PARTICIPATION IN THE ACTIVITY, DURING THIS INITIAL AND ALL SUBSEQUENT EVENTS OF PARTICIPATION. THIS AGREEMENT was entered into at arm's-length, without duress or coercion, and is to be interpreted as an agreement between two parties of equal bargaining strength. Both and Erin Bennetts (Owner of Erin Bennetts LLC) agree that this agreement is clear and unambiguous as to its terms, and that no other evidence shall be used or admitted to alter or explain the terms of this agreement, but that it will be interpreted based on the language in accordance with the purposes for which it is entered into. In the event that any provision contained within this Release of Liability shall be deemed to be severable or invalid, or if any term, condition, phrase or portion of this agreement shall be determined to be unlawful or otherwise unenforceable, the remainder of this agreement shall remain in full force and effect. If a court should find that any provision of this agreement to be invalid or unenforceable, but that by limiting said provision it would become valid and enforceable, then said provision shall be deemed to be written, construed and enforced as so limited. Agree Photo Use Release Form I hereby grant and authorize Social Skills Summer Camp the right to take, edit, alter, copy, exhibit, publish, distribute and make use of any and all pictures or video taken of me by Social Skills Summer Camp to be used in and/or for legally promotional materials including, but not limited to, newsletters, flyers, posters, brochures, advertisements, fundraising letters, annual reports, press kits and submissions to journalists, websites, social networking sites and other print and digital communications, without payment or any other consideration. This authorization extends to all languages, media, formats and markets now known or hereafter devised. This authorization shall continue indefinitely, unless I otherwise revoke said authorization in writing. I understand and agree that these materials shall become the property of Social Skills Summer Camp and will not be returned. I hereby hold harmless, and release Social Skills Summer Camp from all liability, petitions, and causes of action which I, my heirs, representative, executors, administrators, or any other persons may make while acting on my behalf or on behalf of my estate. Agree Decline Photo use and Release Name of Parent/Legal Guardian completing waivers * First Name Last Name Date MM DD YYYY Thank you! Child Information FormComplete this form for EACH child attending Social Skills Summer Camp Complete Child Information Form Child Information Form Name * First Name Last Name Date of Birth * MM DD YYYY Grade entering school year 2023-2024 * 1st 2nd 3rd 4th 5th 6th Child's Gender * Medical Conditions * None Asthma Allergies Seizure Disorders Diabetes Other (provide information in next field) Medical Conditions Please add information about any past or current medical conditions/concerns that may impact child's ability to engage in Social Skills Summer Camp Mental Health Information * History of mental health diagnosis or identication as Neurodivergent Anxiety Depression Trauma Autistic ADD Sensory Processing Differences Other (Provide information below) None Mental Health Information Please provide any additional info about current mental health conditions or neurodivergent identify that may affect participation in Social Skills Summer Camp Medications to be given during Social Skills Summer Camp * Parent to provide medications that are clearly labeled as well as copy of paperwork given to school (school year 2022-2023) that includes Doctors name and instructions No Medications to be given during Camp I agree to provide medications, I authorize Erin Bennetts to administer medications as directed (copy of 2022-2023 school paperwork provided) Limitations for participation in Social Skills Summer Camp Please let us know if your child has any restrictions that may affection their participation in all activities during Social Skills Summer Camp What to send with your child everyday Every day we will be playing outside, running/jumping, engaging in activities that may be messy! You agree to (check each box): Send my camper in comfortable clothing that they can play, run, jump, stretch and get messy in Send my camper in closed toe shoes (no flip flops/sandals, dress shoes) Provide 2 (nut free) snacks Provide lunch (nut free items only) Water Bottle Will apply sunscreen prior to arrival Agree child can utilize sunscreen provided by Social Skills Summer Camp for reapplication (or if they forgot to apply before arrival) Agree I will not send electronic devices with my camper (phones allowed but will be collected at start of camp day and returned at end of the day) Thank you!