2019 My Brain Camp Waiver
Waiver and registration to the ultimate inclusified self development camp for all. Camping and the outdoors can be dangerous and may serious injury even death
Your first and last name *
Your answer
your email address *
Your answer
your phone number beginning with the area code *
Your answer
how many will be in your party all persons responsible for them-self must fill in a registration from and the waiver we will have some waivers at camp if number should change *
Your answer
how many will be in your party all persons responsible for them-self must fill in a registration from and the waiver we will have some waivers at camp if number should change *
Your answer
Please list all the persons under 18 years of age that you are responsible for and your relationship to the person ie. name - relationship or if you are on another persons registration who that is *
Your answer
this is a 7 day private camp and there is no charge to camp grants and donations have made that possible this year any donation to camp will be used for camp purposes meals are on your own if you with you can purchase 12 meals for $55 follow this link https://squareup.com/store/people-first-tbi-network/item/my-brain-camp-meals *
1. I wish to participate in My Bran Camp I understand that my execution of this Waiver and Release is a prerequisite for participation in camp. I further understand that there are risks and dangers inherent in participating in camp and its activities *
Required
2. I understand that in order to be allowed to participate in the Camp, I agree to assume all risks and to release and hold harmless My Brain Camp, People First of Washington and their officers, agents, employees, assigns, successors in interest, contractors, vendors (and their agents), agencies, sponsors, officials and volunteers, including host families, camp facilitators, participating communities and clubs and all governmental and public entities including, but not limited to, the State, County and local municipalities where the program takes place (collectively the “Released Parties”). 3. I intend by this Waiver and Release to release, in advance, and to waive my rights and to indemnify, defend, and hold harmless the Released Parties with respect to any cost, expense, liability or damage, including reasonable attorneys’ fees and expenses related to the investigation or defense of any claims (collectively, “Damages”) incurred if and to the extent that such Damages result from claims resulting from the activities or on account of any actions, negligent or otherwise, of the Released Parties. I understand and agree that this Waiver and Release is binding on my heirs, assigns, and legal representatives.. *
Required
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4. By checking and filling this out I understand that I am solely responsible for any and all loses as described and I my or may not have adequate personal property and liability insurance to cover any and all contingencies during the entire duration of the camp, including all travel time. I may also be required to subscribe, at my own expense, to medical, life, personal property, liability, or other type of insurance, as deemed appropriate by the host My Brain Camp, 5. I understand that I am solely responsible for my health and safety, and I acknowledge that I am physically capable of participating in My Brain Camp and any of the activities i will choose to do *
Required
5. I understand that I am solely responsible for my health and safety, and I acknowledge that I am physically capable of participating in My Brain Camp and any of the activities i will choose to do 6. I agree to allow My Brain Camp, People First of Washington, TBINetwork, and their contractors, agencies and sponsors, the use of my likeness in connection with the Camp, for any purpose related to advertising or promotion of the event worldwide in perpetuity in all forms of media now and forever known, no personal information, location will ever be given out. 7. Should any portion of this Waiver and Release be judicially determined invalid, voidable, or unenforceable for any reason, such portion of this Waiver and Release shall be severable from the remaining portions herein and the invalidity, voidability, or unenforceability thereof shall not affect the validity, effect, enforceability, or interpretation of the remaining provisions of this Waiver and Release. *
Required
8. I have carefully read this Waiver and Release and fully understand its contents. My parent or legal guardian has completely reviewed this Waiver and Release, understands and consents to its terms, and authorizes my participation by his/her signature below. I am aware that this is a RELEASE OF LIABILITY and a contract between me and the persons and entities mentioned above and I sign of my own free will. *
Required
This is a digital signature of camp participant below and i swear under penalty of law that signature is who it says it is *
Your answer
This is a digital signature of parent and or guardian and i swear under penalty of law that signature is who it says it is *
Your answer
Medical Information - Please note that during My Brain Camp all persons under 18 years of age are required to be accompanied by a parent, guardian or another adult who has agreed to be responsible for the child. Parents, guardians and responsible adults will be responsible for the health and safety of the children under their care. The information provided below is given for purposes of medical emergencies when a parent, guardian or responsible adult is not available to provide for medical decisions and care. please list emergency contact phone and any know medical conditions and allergies
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