Seek Adventures, LLC - Camp Application
TWO WAYS TO SUBMIT THIS FORM
Print, complete, photograph and e-mail to
seekadventures@live.com
OR
Print, complete and mail to address below
Camper's name ____________________________________________________
Mom's name/phone ________________________________________________
Dad's name/phone
________________________________________
Home address
___________________________________________
Email address
___________________________________________
Dates for camp attending (1st choice) ______________ (2nd choice) _________
Will you use Huntsville bus service? Yes No T-shirt size: Y/L A/S A/M A/L A/XL
DOB ______ / ______ / _______ Height _______ Weight _______
Biological sex at birth: Male Female ADD/ADHD: none mild high
Angry or combative behavior: normal high
Ability to receive instruction: low normal Swimming ability: poor good strong
List any allergies:
Physical or emotional health comments:
List any medications he is currently taking:
Camper's doctor's name &
phone ___________________________________
I give Seek Adventures LLC staff permission to obtain emergency medical treatment, including emergency transportation, if I cannot be reached immediately.
____________________________________ / ______________
parent or legal guardian’s signature / date
PARENT
OR GUARDIAN’S AGREEMENT WITH SEEK ADVENTURES LLC:
STATEMENT OF RISK INVOLVED WITH OUTDOOR ACTIVITIES:
Seek Adventures, LLC does not carry medical insurance for
campers. Seek Adventures LLC will
attempt in every way to provide a safe environment for campers and staff.
Great care will be taken to insure the total well being of each camper.
However, outdoor activities such as rock climbing, ropes courses,
canoeing, swimming, kayaking, backpacking, running games and a wide variety of
other activities and transportation to and from activities do involve an unknown amount of risk.
These risks could include, but are not limited to, inclement weather,
natural hazards, human error or mechanical malfunction of equipment and road hazards; possibly
resulting in, but not limited to, being struck by lightning, poisonous snake or
spider bites, parasites, poison ivy, falling trees or limbs, hypothermia, bruises, cuts, broken
bones, drowning, loss of
use of body members or death.
A.
SAFETY RISKS INVOLVED WITH OUTDOOR ACTIVITIES AND TRANSPORTATION:
I
agree that there are safety risks involved with outdoor activities such as those
in which my child will be engaged while at camp with Seek Adventures LLC.
I have read the statement of risk above and am aware of the risks involved with
this camp and I am willing to allow my child to participate even though these
risks exist.
B.
ACCEPTANCE OF RESPONSIBILITY:
I
agree to accept and assume all risks existing in these activities.
By my acceptance of the risks of these activities, I agree to be solely
responsible for any injuries or sickness my child may incur while at camp with Seek
Adventures LLC. I also agree to hold
blameless Seek Adventures, LLC for any injuries or sickness.
C.
PAYMENT FOR MEDICAL ATTENTION:
I
agree to be responsible for the cost of any medical attention, including
emergency transportation, my child needs as a result of any injuries or sickness
my child may incur
while at camp with Seek Adventures LLC.
D. PARTICIPATION PARAMETERS: Being a camper with Seek Adventures is a privilege not a right. Campers must meet certain behavioral standards in order to be part of the program. If a camper is believed to be putting others or himself in danger or if the camper's behavior is deemed unacceptable in any other way, the camper will be sent home without any refund of camp fees. Further, I agree that if the information in this application is found to be incorrect or misleading, the camper will be sent home without any refund of camp fees.
E. REFUND POLICY: Full refund less $50 is available up to 30 days before session start date. Half cost is available up to 10 days before session start date. No refund within 10 days of session start date.
F. APPLICATION PROCESS: I understand Seek Adventures LLC accepts campers by application process and that not all applicants may be chosen to attend camp sessions. I agree Seek Adventures LLC has the right to deny an applicant without any specified reason.
I as parent or legal guardian of the above named camper have read, understand and accept the terms of this agreement as outlined in A, B, C, D, E and F above. Further, I confirm all information in this application is accurate and truthful
____________________________________ / ______________
parent or legal guardian’s signature / date
Payment is due by April 30 to receive early discount
E-mail to: seekadventures@live.com
OR
Mail to: Seek Adventures, 1609 W. Limestone Road, Hazel Green, AL 35750