See page in
Si tu veux remplir le formulaire dans la version française, click ici pour une version téléchargée du document pdf que tu pourras ensuite imprimer.
If you have any questions or need help with any aspect of this form, please don’t hesitate to contact us at 802-858-6489.
Si tu as des questions ou besoin d’aide en remplissant ce formulaire, n’hésite pas à communiquer avec nous au (802) 858-6489
We will only accept registrations of children whose parents have read and signed our Waiver and Understanding of Risks. To submit your registration online, you must read the below Waiver and sign electronically, by checking the box below it. We also offer the option to download and print out our registration form, including the Waiver and Understanding of Risks, for those who prefer to sign a paper signature.
I clearly understand that by taking part in the Play in the Wild! Kids Camp – July 9th to 13th, 2018 and July 16th to 20th, 2018 at Wild! Heart Refuge in Jeffersonville, Vermont, USA, me/ my child or pupil will be exposed to some risks (up to and including, but not limited to, injury or death). I have been so informed by Catherine Cadden (if not before, then now through this form) and have taken the opportunity to have all my questions and concerns answered to my satisfaction. With full knowledge of the risks, I still choose/allow myself/my child or pupil to take part in this program. I hereby accept the risks of injury or death involved in my/my child or pupil’s participation in the Wild! Kids Camp.
In consideration of the participation of my child or pupil (hereinafter referred to as « the Participant ») in the Wild! Kids Camp, I, as parent or guardian of the Participant, DO HEREBY RELEASE, INDEMNIFY, HOLD HARMLESS, WAIVE, DISCHARGE AND COVENANT NOT TO SUE Catherine Cadden, Jesse Wiens, Play in the Wild!, or their representatives, directors, officers, employees, animators, or agents and each of them herein are released and discharged from any liability to the undersigned and the Participant, and their respective representatives, assigns, heirs, executors and next of kin for all losses or damages to the Participant during or in relation to its participation in the Wild! Kids Camp.
I do further authorize Catherine Cadden, and/ or Jesse Wiens to consent on my behalf to any emergency medical treatment by a properly licensed person, which may be required for the Participant, and do agree to indemnify and hold harmless anyone giving such consent. I, parent or guardian, understand I will be notified immediately of any decision for emergency transport for medical treatment.
I do further agree that any photos or film footage or sound recordings of the “Participant” become the property of Play in the Wild! to be utilized at their discretion for use in advertising in print or on the internet. I can ask at anytime to not have my or my child’s photo or a recording of my image or my child’s image taken while at camp and that will be upheld and respected.
I acknowledge and declare that I have been given sufficient time and opportunity to understand the terms of this Waiver and Understanding of Risks, and that I fully understand such terms and agree to be bound by them. I have expressly requested that this document and all documents related thereto be drafted in English and/or the language I can best understand and comprehend what it is that I am signing. J’ai expressément requis que la présente Renonciation et reconnaissance des risques et tous les documents y afférents soient rédigés en langue anglaise. This document also constitutes a transaction pursuant to the Civil Code of Québec.
Numéro de carte
Please make your check out to « Baba Tree International » and mail to Baba Tree International/ Play in the Wild!, P.O. Box 46, Jeffersonville, VT 05464 USA. Please write the name of the child you are registering in the memo of the check.
To complete payment, please call our office between 9am and 5pm, Monday through Thursday, U.S. Eastern time, at 802-858-6489 and have your credit card information ready.