Consent/Health Form
Camp Terms & Conditions/Waiver & Release of Liability/Health form

READ BEFORE SIGNING

By signing below, I/we (Parent/Guardian of Participant and Participant) agree to the following terms and conditions of participating in the Camp provided by Stuy Town Baseball Camp, Inc.
Email address *
Camper's Name *
Your answer
Sex *
Age *
Your answer
Home Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Daytime Phone *
Your answer
Evening Phone *
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Phone *
Your answer
1. Medical Condition & Authorization *
I certify that the named Participant is physically able to participate in the Stuy Town Baseball Camp and that I know of no restrictions, physical impairments, or any other facts, which in any manner limit his/her participation in such a program. I also understand that Stuy Town Baseball Camp will administer no physical examinations and that Stuy Town Baseball Camp will rely solely upon the information shown on this form. I give permission for Participant to receive emergency medical or surgical treatment and hospitalization if necessary. I hereby authorize directors, coaches, staff and associates of Stuy Town Baseball Camp to act on my behalf according to their best judgment in any emergency requiring medical or surgical treatment and hospitalization if necessary.
2. Financial Responsibility & Insurance *
I will be financially responsible for any medical attention needed during the Camp or resulting from an injury received at Camp. I represent that I have provided and maintain adequate health and medical insurance coverage for Participant covering any and all activities related to the Camp. My medical insurance shall be the insurance coverage for any medical treatment. I also understand and agree that Stuy Town Baseball Camp shall not assume, or be responsible or liable for expense, medical treatment, or compensation for any injury to the named Participant may suffer during Camp participation or related activities.
3. Compliance with Camp Rules *
Participant understands and agrees to comply with all of the Stuy Town Baseball Camp, Camp rules, policies and stated and customary terms, conditions or requirements for participation (Camp Rules) including any rules or conditions of any hotel or transportation service provider in which participant uses during the Camp. I/we agree that if you observe any unusual or significant concern in Participant’s readiness for participation in the Camp or participant’s failure or unwillingness to comply with the Camp Rules, you may, at your sole discretion, will remove participant from the participation and immediately inform the nearest Stuy Town Baseball Camp official. Also, I/we hereby release and forever discharge Stuy Town Baseball Camp, from any and all claims, actions, damages, or liabilities (including attorneys' fees and costs), arising from or related to any acts, actions, failures to act by Participant or Participant's disregard or failure to follow Camp Rules.
4. Assumption of Risk of Camp Activities *
I understand the risk of injury to Participant from the activities involved in the baseball Camp is significant, including the potential for permanent disability and death. The term “Camp Activities” includes but is not limited to: travel to and from Camp, activities on and off the field, activities before and after field instruction at any hotel or third party facilities at which a Camp activity or function is conducted. While the particular Camp rules, equipment and personal discipline may reduce this risk, the risk of serious injury does exist. I/we (Parent/Guardian and Participant) knowingly and freely assume all such risks, both known and unknown, even if arising from the negligence of Stuy Town Baseball Camp, and its Coaches, Staff, Camp Management, and Directors and I/we assume full responsibility for participation in Camp by Participant.
5. Release & Hold Harmless *
I/we for myself and on behalf of Participant hereby release and hold harmless Stuy Town Baseball Camp, and its Coaches, Staff, Camp Management, Directors, Sponsors, Representatives, volunteers and if applicable the owners and lessors of the premises used to conduct the Camp (Releases) with respect to any and all injury, disability, death or loss or damage to person or property incident to participant’s involvement or participation in any and all Camp activities whether arising from the negligence of releases or otherwise, to the fullest extent permitted by law.
6. Indemnity *
I/we, for myself and on behalf of Participant, hereby indemnify and hold all of the above Releases from any and all liabilities incident to Participant’s involvement or participation in any and all Camp activities whether arising from the negligence of releases or otherwise, to the fullest extent permitted by law.
7. Payment *
Registration forms & fee/deposit must be paid in full prior to attending Camp. Payment can be made in full online at time of registration or the first day of the camp session. Parent / legal guardian agrees to have payment by the start of camp session, or Stuy Town Baseball Camp will automatically charge the credit card on file. If final payment is not made, no refund will be given on any deposit. A no show fee for a registered participant is $50 a day (there are medical exceptions).
8. Cancellation Policy *
A full Camp credit will be issued to you if for any reason you must cancel your Stuy Town Baseball Camp registration. Credit is good for the current season or following Camp seasons. Cash refunds are granted only if you have purchased Refund Insurance (see below). Stuy Town Baseball Camp reserves the right to cancel a Camp for any reason without prior notice. In this case, full refund is given for all monies collected by Stuy Town Baseball Camp only. Stuy Town Baseball Camp will not be responsible for other incidental fees incurred in conjunction with the Camp.
9. Refund Insurance *
Refund insurance is not included in the Camp price. Refund insurance, if desired, must be purchased separately at the time of registration. Refund Insurance entitles you to a full refund of Camp fees should you cancel your registration more than 14 days prior to the start of your session. If you cancel within 14 days of your registered session, we will give you a Camp credit for all monies paid, valid for 3 years. Credit with insurance is transferable to family members or friends, and good toward all Stuy Town Baseball Camp.
10. Publicity *
I understand and agree Stuy Town Baseball Camp retains the right to use, for publicity and advertising, photographs of Campers taken at Camp.
11. Limitation of Liability *
I agree that the total liability of Stuy Town Baseball Camp, Inc., its affiliates and respective directors, officers, employees, and agents with respect to services performed or to be performed by Stuy Town Baseball Camp, shall not exceed 100% of the compensation received by Stuy Town Baseball Camp, Inc., from me pertaining to Participant. The parties agree and acknowledge this Section of the agreement is a material part of the consideration for the Agreement.
12. Severability *
In the event that any provision of these Terms and Conditions, or the application of any such provision to any person or set of circumstances, shall be determined to be invalid, unlawful or unenforceable, the remainder of these Terms and Conditions shall continue to be valid and enforceable to the fullest extent permitted by law.
13. Governing Law & Jurisdiction *
These Terms and Conditions will be governed by the law of the state in which the Camp is conducted. I/we agree that any action brought under these Terms and Conditions shall be brought in the federal or state courts of Washington. In the event either party commences an action under these Terms and Conditions, the prevailing party shall be entitled to reasonable attorney’s fees and costs.
Have You Done The Following *
I/WE HAVE READ THESE CAMP TERMS & CONDITIONS AND WAIVER & RELEASE OF LIABILITY, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I/WE HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT. Participant’s Understanding of Risk. I, Participant, understand the seriousness of the risks involved in participating in this Camp, my personal responsibilities for following the Camp Rules and accept them as a Participant.
Name of Parent/Guardian *
Your answer
Name of Parent/Guardian *
Your answer
Health & General Medical History
If the player should be restricted from any activity, please explain (If not write N/A) *
Your answer
If the player will be taking medication during the camp, please indicate drug and dosage (If not write N/A) *
Your answer
Please identify any medical condition or medical history that will/may require special attention (If not write N/A) *
Your answer
Please Check any of the following conditions that apply *
Required
Please Check if the camper has had any of the following *
Required
Emergency Contact (Name) *
Your answer
Relationship to Camper and Guardian *
Your answer
Phone *
Your answer
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