Barefoot All Access Reservation Form
Please complete the reservation form in detail and submit to the reservation team. Upon receipt of your form, you will receive a confirmation email with an invoice for payment. Final Booking will be confirmed upon receipt of payment.
Email *
First Name *
Last Name *
Phone # *
Billing Address (# Street Name, City, State, & Zip) *
County *
ALL ACCESS CAMP SPECIFICS
Requested Arrival Date: *
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CAMP PROGRAM - Please select which program *
Estimated Arrival Time - We are flexible; however, please provide an estimated arrival time so that we can ensure our staff is available to welcome and orient you. *
If Overnight Stay, how many nights *
For Overnight Guests, please confirm the following *
HOW MANY PEOPLE ARE IN YOUR PARTY
Each cabin sleeps 6 people and does require at least 1 person 18 years or older in order to book.
Adults (Ages 18 & Up) Day Pass: $40; Overnight Pass: $85; & Overnight Tent Pass: $60 *
Please list the name(s) and ethnicity of each adult in your party. (For example: John Smith, African-American) *
Kids (Ages 6 - 17) Day Pass: $30; Overnight Pass: $60; & Overnight Tent Pass: $35 *
Please list the name(s), age and ethnicity of each child (Ages 6-17) in your party. (For example: John Smith, 9, African-American)
Kids (Ages 5 & under) (No Charge) *
Please list the name(s), age and ethnicity of each child (Ages 5 & under) in your party. (For example: John Smith, 3, African-American)
Are you bringing any Pet(s) - Please note: We have limited number pet friendly cabins. *
MEALS
Menu options will be provided onsite. Please select the total numbers of Meals per day for your group.
Please select which Meal Options you would like to add for each day of your stay. Meals are $10 per meal per person.
Breakfast
Lunch
Dinner
I do not want any meals.
Day 1
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7
Please list any allergies of those in your group. Please specify their name when applicable.
PROGRAM SPECIFICS
There are self-guided programming options, as well as, facilitated activities included in your visit. Self-guided programming is available at your leisure. However, in order to help us prepare for your visit, please share your facilitated activities interest.
Please select your Top 3 choices of the Facilitated Activities you be interested in participating in during your stay. *
Required
PAYMENT INFORMATION
Upon confirmation of your order, you will receive an invoice with your balance. Please indicate any things to note relative to your payment.
How do you intend to pay? *
Financial Assistance is provided on a sliding scale, please let us know how much you can pay towards your fees.
How did you hear about Barefoot All Access? *
WAIVER - Required for Booking
Date of Birth (Must be 18 years or older to book and sign off on the waiver) *
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Participant Waiver, Release, Indemnification of All Claims & Covenant Not to Sue NOTICE: THIS IS A LEGALLY BINDING AGREEMENT. Read this document carefully and in entirety. By signing this agreement, you give up your right to bring a court action to recover compensation or obtain any other remedy for any personal injury or property damage however caused arising out of your participation in Barefoot Republic Camp Programs and Residency on Campus, now or at any time in the future.Acknowledgment of RiskI hereby acknowledge and agree that participation in Barefoot All Access activities comes with inherent risks. Additionally, I, in my legal capacity as the parent/guardian of the minor included in this booking, do hereby acknowledge and agree that participation in Barefoot All Access activities comes with inherent risks. I have full knowledge and understanding of the inherent risks associated with Barefoot All Access participation, including but in no way limited to: (1) slips, trips, and falls, (2) aquatic injuries, (3) athletic injuries, and (4) illness, including exposure to and infection with viruses or bacteria. I further acknowledge that the preceding list is not inclusive of all possible risks associated with Barefoot All Access participation and that said list in no way limits the operation of this Agreement. Coronavirus / COVID-19 Warning & DisclaimerCoronavirus, COVID-19 is an extremely contagious virus that spreads easily through person-to-person contact. Federal and state authorities recommend social distancing as a means to prevent the spread of the virus. COVID-19 can lead to severe illness, personal injury, permanent disability, and death. Participating in Barefoot Republic Camp programs or accessing Barefoot Republic Camp facilities could increase the risk of contracting COVID-19. Barefoot Republic Camp in no way warrants that COVID-19 infection will not occur through participation in Barefoot Republic Camp programs or accessing Barefoot Republic Camp facilities.Waiver, Release, Indemnification & Covenant Not to SueIn consideration of my participation in Barefoot Republic Camp’s Barefoot All Access, I, agree to release and on behalf of myself, my heirs, representatives, executors, administrators, and assigns, HEREBY DO RELEASE Barefoot Republic Camp, its officers, directors, employees, volunteers, agents, representatives and insurers (“Releasees”) from any causes of action, claims, or demands of any nature whatsoever including, but in no way limited to, claims of negligence, which I, my heirs, representatives, executors, administrators and assigns may have, now or in the future, against Barefoot Republic Camp on account of personal injury, property damage, death or accident of any kind, arising out of or in any way related to the use of Barefoot Republic Camp facilities/equipment or participation in Barefoot Republic Camp programs whether that participation is supervised or unsupervised, however the injury or damage occurs, including, but not limited to the negligence of Releasees. Additionally, as the parent/guardian of the minor named above, agree to release and on behalf of myself and the minor named above, my heirs, representatives, executors, administrators, and assigns, HEREBY DO RELEASE Barefoot Republic Camp, its officers, directors, employees, volunteers, agents, representatives and insurers (“Releasees”) from any causes of action, claims, or demands of any nature whatsoever including, but in no way limited to, claims of negligence, which I, the named minor, my heirs, representatives, executors, administrators and assigns may have, now or in the future, against Barefoot Republic Camp on account of personal injury, property damage, death or accident of any kind, arising out of or in any way related to the use of Barefoot Republic Camp facilities/equipment or participation in Barefoot Republic Camp programs whether that participation is supervised or unsupervised, however the injury or damage occurs, including, but not limited to the negligence of Releasees. In consideration of my participation in Barefoot All Access, I, the undersigned participant, agree to INDEMNIFY AND HOLD HARMLESS Releasees from any and all causes of action, claims, demands, losses, or costs of any nature whatsoever arising out of or in any way related to my Barefoot All Access participation. Additionally, as it relates to all minors included in this booking, in consideration of the named minor’s participation in Barefoot All Access, I, the undersigned parent/guardian of the named minor, agree to INDEMNIFY AND HOLD HARMLESS Releasees from any and all causes of action, claims, demands, losses, or costs of any nature whatsoever arising out of or in any way related to the named minor’s Barefoot All Access participation.I hereby certify on behalf of myself and the named minor that I have full knowledge of the nature and extent of the risks inherent in Barefoot All Access participation and that I, on behalf of myself and the named minor, am voluntarily assuming said risks. I understand that I and the named minor will be solely responsible for any loss or damage, including personal injury, property damage, or death, the named minor sustains while participating in Barefoot All Access and that by signing this agreement I, on behalf of myself and the named minor, HEREBY RELEASE Releasees of all liability for such loss, damage, or death. I further certify that I am in good health and that I have no conditions or impairments which would preclude my safe participation in Barefoot All Access. I further certify that the named minor is in good health and has no conditions or impairments which would preclude his/her safe participation in Barefoot All Access. I hereby certify that I have full knowledge of the nature and extent of the risks inherent in Barefoot All Access participation and that I am voluntarily assuming said risks. I understand that I will be solely responsible for any loss or damage, including personal injury, property damage, or death, I sustain while participating in Barefoot All Access and that by signing this agreement I HEREBY RELEASE Releasees from all liability for such loss, damage, or death. I further certify that I am therefore of lawful age (18 years or older) and otherwise legally competent to sign this agreement. I further understand that the terms of this agreement are legally binding and certify that I am signing this agreement, after having carefully read it, of my own free will. By submitting this booking request, I, the undersigned and the parent or guardian of the child whose name appears above, agree that myself, and all those included in this reservation request, have permission to participate in all camp activities (except as stated above) and agree that this camper and I have reviewed and agreed upon Barefoot Republic Camp’s policies and conditions of enrollment. I hereby release and fully discharge Barefoot Republic Camp, Inc. its staff and affiliates from any liability while myself and all parties listed above are at camp and realize that every effort for safety will be made. This waiver of liability includes any damage or injury that results from myself or the parties listed above’s participation in the camp’s activities or programs, including transportation to and from camp; any off-site trips, such as for programming needs or in the event of rain or emergency; and to the extent that any such damage or injury may be caused wholly or in part by any act or omission, whether or not by reason of negligence, of Barefoot Republic Camp or due to the condition or design or any defect in any building, bus or equipment used by or at camp. I understand that in case of an emergency, every effort will be made to contact me. In the event I cannot be reached, I hereby give permission to the licensed health-care practitioner selected by the Executive Camp Director to secure proper treatment, including hospitalization, anesthesia, surgery or injections of medication for this camper. I authorize Barefoot Republic Camp to have and use photographs and video footage of this camper as needed for promotional purposes. I understand that the Executive Camp Director has the right to send home any camper not complying with the camp rules and regulations without a refund of any kind. I also agree to take full responsibility for any property damage caused by myself or any of the parties listed on the above reservation request. *
Thank You!
Thank you for booking with Barefoot All Access! We look forward to hosting you!
A copy of your responses will be emailed to the address you provided.
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