SUMMER CAMP BOOKING FORM

Please read and complete the required Covid-19 waiver by clicking the button.

 

 

 

Once complete, proceed filling out the participation registration and 

medical information below in order to proceed to payment

PARTICIPANT REGISTRATION & MEDICAL FORM

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MEDICAL INSURANCE INFORMATION

MEDICATION

Medication(s) needed by a camper may be administered by a properly licensed healthcare professional or distributed by Program Staff for self-administration by the Minor under the following conditions: (a) parent/legal guardian must provide written authorization, (b) parent/legal guardian must provide the medicine in its original labeled pharmacy container for prescription medication or in the manufacturer’s container for over-the counter medications along with the camper’s name, medicine name, dosage and timing of consumption for prescription medication, (c) medicine should be kept in an appropriate and secure location, (d) a record showing the date, time, and signature of the person who administered or witnessed each self-administration of medicine must be kept for 90 days, (e) any medicine the camper cannot self-administer must be stored and administered by a licensed healthcare professional associated with the campus, or if no one is available, arrangements must be made with another healthcare professional in advance of the participant’s arrival, (f) personal “epipens and inhalers may be carried by the participant during activities.

PARENT AUTHORIZATION FOR MEDICATION:

I give permission for my child to take the above listed medication(s) as directed on the packaging and give permission for the medication(s) to be administered to my child by Next9Up personnel as needed according to the instructions provided.

**NOTE: Signature required only for those with medication(s) in their possession while attending camp.

ALLERGIES

PARENT AUTHORIZATION & PERMISSION TO TREAT:

*The above provided medical history is correct to the best to my knowledge and I give permission for the Next9Up staff to administer first aid and/or to provide the appropriate transportation to a medical facility to receive adequate medical care in the event of any injury or illness.

All campers are required to provide the latest copy of their physical and immunization history. These can be emailed to dryan14@next9up.com or brought on the first day of camp.

PARENT/GUARDIAN EMERGENCY CONTACT INFORMATION (To be contacted in event of illness or injury)

NEXT9UP CAMPER PICKUP RELEASE

 I give permission for my child to be released from Next9Up's baseball/softball clinic and/or received at the end of camp to the following people: 

We will not release your child to anyone that is not on the list without verifiable written instructions from the child’s legal guardian. Upon a child’s pickup, picture identification will be required for verification. 

RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AND PARENTAL CONSENT AGREEMENT 

("AGREEMENT")  

IN CONSIDERATION of being permitted to participate in any way in Next9Up, activities ("Activities") I, for myself for personal representatives, assigns, heirs, and next of kin:  

1. ACKNOWLEDGE, agree, and represent that I understand the nature of Next9Up Activities (which includes promotional videos and pictures) and that I am qualified,  in good health, and in proper physical condition to participate in such Activities. I further agree and warrant that if at any time I  believe conditions to be unsafe, I will immediately discontinue further participation in the Activity.

 

2. FULLY UNDERSTAND THAT: (a) Next9Up ACTIVITIES INVOLVE RISKS AND DANGERS OF SERIOUS BODILY  INJURY, INCLUDING PERMANENT DISABILITY, PARALYSIS, AND DEATH ("RISKS"); (b) these Risks and dangers may be caused by  my own actions or inactions, the actions or inactions of others participating in the Activity, the condition in which the Activity takes  place, or THE NEGLIGENCE OF THE "RELEASEES" NAMED BELOW; (c) there may be OTHER RISK AND SOCIAL AND ECONOMIC  LOSSES either not known to me or not readily foreseeable at this time; and I FULLY ACCEPT AND ASSUME ALL SUCH RISKS AND ALL  RESPONSIBILITY FOR LOSSES, COSTS, AND DAMAGES I incur as a result of my participation or that of the minor in the Activity.  

3. HEREBY RELEASE, DISCHARGE, AND COVENANT NOT TO SUE Next9Up, their respective administrators,  directors, agents, officers, members, volunteers, and employees, other participants, any sponsors, advertisers, and, if applicable, owner and lessors of premises on which the Activity takes place, (each considered one of the "RELEASES" herein) FROM ALL  LIABILITY, CLAIMS, DEMANDS, LOSSES, OR DAMAGES ON MY ACCOUNT CAUSED OR ALLEGED TO BE CAUSED IN WHOLE OR IN  PART BY THE NEGLIGENCE OF THE "RELEASEES" OR OTHERWISE, INCLUDING NEGLIGENT RESCUE OPERATIONS AND I FURTHER  AGREE that if, despite this RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT I, or anyone  on my behalf, makes a claim against any of the Releasees, I WILL INDEMNIFY, SAVE, AND HOLD HARMLESS EACH OF THE  RELEASEES from any litigation expenses, attorney fees, loss, liability, damage, or cost which may incur as the result of such claim.  

I HAVE READ THIS AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY  SIGNING IT AND HAVE SIGNED IT FREELY AND WITHOUT INDUCEMENT OR ASSURANCE OF ANY NATURE AND INTEND IT TO BE A  COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW AND AGREE THAT IF  ANY PORTION OF THIS AGREEMENT IS HELD TO BE INVALID THE BALANCE, NOTWITHSTANDING, SHALL CONTINUE IN FULL FORCE  AND EFFECT.  

MINOR RELEASE

AND I, THE MINOR’S PARENT AND/OR LEGAL GUARDIAN, UNDERSTAND THE NATURE OF NEXT9UP ACTIVITIES AND THE  MINOR’S EXPERIENCE AND CAPABILITIES AND BELIEVE THE MINOR TO BE QUALIFIED, IN GOOD HEALTH, AND IN PROPER  PHYSICAL CONDITION TO PARTICIPATE IN SUCH ACTIVITY. I HEREBY RELEASE, DISCHARGE, COVENANT NOT TO SUE, AND AGREE  TO INDEMNIFY AND SAVE AND HOLD HARMLESS EACH OF THE RELEASEE’S FROM ALL LIABILITY CLAIMS, DEMANDS, LOSSES, OR  DAMAGES ON THE MINOR’S ACCOUNT CAUSED OR ALLEGED TO BE CAUSED IN WHOLE OR IN PART BY THE NEGLIGENCE OF THE "RELEASEES" OR OTHERWISE, INCLUDING NEGLIGENT RESCUE OPERATION AND FURTHER AGREE THAT IF, DESPITE THIS  RELEASE, I, THE MINOR, OR ANYONE ON THE MINOR’S BEHALF MAKES A CLAIM AGAINST ANY OF THE RELEASEES NAMED ABOVE, I  WILL INDEMNITY, SAVE, AND HOLD HARMLESS EACH OF THE RELEASEES FROM ANY LITIGATION EXPENSES, ATTORNEY FEES,  LOSS LIABILITY, DAMAGE, OR COST ANY MAY INCUR AS THE RESULT OF ANY SUCH CLAIM.  

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