2023 Camp Brave Eagle Registration

Camp Brave Eagle reserves the right to dismiss any child displaying excessive poor behavior at camp which jeopardizes his/her own or other campers’ safety, experience, and welfare. There are some behaviors that result in immediate dismissal. If the behavior does not warrant immediate dismissal, the following will take place:
 
First Offense
Meeting with the Cabin Leader, camper, and IHTC staff. A phone call will be made to the camper’s parents advising of unacceptable behavior. Parent will need to be available after this first call in the event the behavior continues and parent(s) are required to pick up the camper immediately.

Second Offense
Meeting with the Camp Director, camper, IHTC staff, and conference call with parent(s). Parent(s) will be required to pick up their camper if the behavior continues.

Third Offense
Camper will be dismissed from camp. Parent will be notified and will be required to pick up their camper immediately. The Camp Director of Camp Crosley will be informed of all offenses and plan of action.
Behaviors which may result in immediate dismissal include, but are not limited to, the following:

• Any action that could threaten or pose a direct threat to the physical/emotional safety of the child, other children, or staff. Prohibited conduct may include, but is not limited to, abusive jokes, insults, slurs, threats, name calling, bullying, or intimidation.
• Fighting
• Possession of a weapon of any kind
• Vandalism or destruction of YMCA property or property of others
• Sexual misconduct
• Possession of or use of alcohol or controlled substances unless under the prescription of a physician
• Running away
• Biting
• Use of profanity

I have read, understand and agree with the Camp Brave Eagle Discipline Policy stated in this document and have discussed the expectations of behavior with my child.

Signature*   
Parent/Legal Guardian Signature (Discipline Policy)

Type Name*   
Type Parent/Legal Guardian's Name of Signature Above

Date*      
Date of Signature

I recognize that the onset of medical symptoms requiring emergency room evaluation for my child is unpredictable. I hereby authorize any medical treatment deemed necessary by IHTC medical staff in attendance at Camp Brave Eagle for my child while my child is at camp. I/we authorize IHTC or anyone else involved with the Camp to secure first aid and/or the services of any legally qualified physician or hospital for Minor and I/we agree to assume any financial obligations incurred.  

I am aware that my child must be covered by medical insurance to attend Camp Brave Eagle.

In the event that my child requires medical care outside of the scope of the IHTC medical staff at Camp Brave Eagle, I agree that my child may be transported by private vehicle to the local hospital. My child’s camp chart, including the most recent physical, medical list, and allergies will accompany him/her.

IHTC will attempt to notify me prior to transporting my child from camp to a medical facility; however, if I am unable to be reached, I authorize IHTC to transport my child as they deem appropriate. I understand that I am required to be present at the clinical site (hospital/medical facility near Camp Crosley) to provide further authorization of medical care for my child, as IHTC staff is unable to remain with my child for the duration of his/her care and stay. I will ensure that I am able, with available transportation, to travel to the clinical site in the event of an emergency.

 
Signature*      
Parent/Legal Guardian Signature (Emergency Consent & Authorization)

Type Parent/Legal Guardian's Name of Signature Above
Type Name*   
    
 Date of Signature
Date*

Indiana Hemophilia and Thrombosis, Inc. (“IHTC”) is collaborating with Camp Crosley (“Camp”). The above-named participant ("Minor") desires to attend the Camp and participate in the associated activities ("Camp Activities"). As consideration for IHTC allowing Minor to attend the Camp and participate in Camp Activities, I/we as the parents and/or legal guardians of Minor, on our behalf and on behalf of Minor, as well as on behalf of our and Minor’s heirs, next of kin, assigns, and personal representatives, hereby agree as follows:

1. Physical Demands and Medical Condition: I/we understand that attending the Camp and participating in Camp Activities involve physical activity that is potentially strenuous and demanding. I/we agree that it is incumbent upon us to advise IHTC of Minor’s activity limitations. I/we and Minor understand that Minor may refrain from any Camp Activities at any time.
2. Assumption of Risks: In addition to the above, I/we understand that Camp attendance and Camp Activities include potentially hazardous activities that involve risks, inherent and otherwise, known and unknown, that cannot be eliminated and that may cause serious physical, emotional or psychological injury, illness, paralysis or even death to Minor, other persons, and/or damage to property. Some, but by no means all, of the risks associated with Camp attendance and Camp Activities include the above referenced physical demands; patent (obvious) or latent (hidden or unobvious) premises or equipment conditions; known and unknown medical conditions; and the acts, omissions and negligence of other Camp attendees, volunteers, staff, Camp employees and other entities involved with Camp. I/we and Minor assume full and sole responsibility for all risks, both known and unknown, inherent or otherwise, related to the Camp and Camp Activities and acknowledge that Minor is voluntarily participating with knowledge and acceptance of the risks.
3. Release of Claims: Acknowledging that such risks exist, I/we and Minor HEREBY RELEASE, WAIVE, DISCHARGE, AND COVENANT NOT TO SUE Indiana Hemophilia & Thrombosis Center, Inc. or its related entities, officers, directors, members, trustees, employees, representatives, agents, insurers, attorneys, owners, volunteers and others involved with the Camp and Camp Activities (hereinafter individually and collectively referred to as the "Released Parties") from any and all claims, damages, losses, actions, suits, proceedings, breach of contract actions, unjust enrichment claims, wrongful death actions, expenses, attorney fees, and liability that I/we, Minor or anyone on our or Minor's behalf (including but not limited to heirs, representatives or next of kin) have or might have for any death, injury, damage (e.g. physical, psychological, emotional or property) or claimed death, injury, or damage allegedly arising out of, involving or relating to Minor's presence at the Camp and/or participation in the Camp Activities. This release applies even if the act or omission complained of was caused in whole or in part by the strict liability or negligence in any form of the Released Parties.
4. Indemnification: I/we further agree to INDEMNIFY, HOLD HARMLESS, AND DEFEND, in any action or proceeding, Released Parties against all claims, lawsuits, losses, damages, actions, suits, proceedings, claims, and expenses, including attorney's fees and costs arising from or relating in any respect to Minor's presence at the Camp and/or participation in the Camp Activities, or a breach of this Agreement. This agreement to indemnify, hold harmless and defend applies even if the act or omission complained of was caused in whole or in part by the strict liability or negligence in any form of the Released Parties.
5. Representations and Agreement to Terms and Conditions: I/we represent that: (i) I/we are at least eighteen (18) years old and the parent or legal guardian of Minor; (ii) have read this document; (iii) have been given an opportunity to ask questions about its contents and/or to seek the advice of an attorney; (iv) fully understand its contents and the waiver of my and Minor's legal rights contained therein; (v) understand that the above release is intended to be as broad as permitted by applicable law; (vi) understand that Minor does not have to attend the Camp and/or participate in any Camp Activity; (vii) and is doing so voluntarily, and without any inducement, and in so doing agree to the terms and conditions set forth therein.
6. Governing Law. This document is governed by the laws of the State of Indiana. Any and all actions arising under this Agreement shall be subject to the exclusive jurisdiction of a State or Federal court sitting in Marion County, Indiana. If one or more portions of this document are found unenforceable, the remainder of the document will remain enforceable.

 

 
Signature*      
Parent/Legal Guardian Signature (Participation Release, Authorization & Agreement for Minors)

Type Parent/Legal Guardian's Name of Signature Above
Type Name*   
    
 Date of Signature
Date*

Although precautions are taken to provide proper organization, instruction, and equipment for your child’s participation in our programs, there can be no guarantee of absolute safety against injury and unforeseeable accident. There are elements of risk in any adventure, sport, or program involving physical exertion and risk taking, or associated with the outdoors (referred to herein as “activity”), and the use of any equipment or animals for the activity. I, on behalf of myself, my child, and any other parent of the child, understand that my child may be involved in activities including but not limited to sailing, water-skiing, horse riding, canoeing, swimming, team building initiatives, boating, ropes course, climbing, rappelling, and/or other physical activities. Some of these activities are rugged adventure recreational activities. I acknowledge that my child may decline to participate in any activity. Any participation will be voluntary.

ACKNOWLEDGMENT OF RISKS: I recognize that there is inherent danger in any activity which involves physical exertion or risk taking; that natural hazards do exist; that although the program may not be strenuous, injuries or medical complications may occur; that certain foreseeable and unforeseeable events unique to each individual activity can contribute to the unpredictability of the activity; that balance and physical coordination may affect the occurrence of accidents or falls; and that I should ask about other potential hazards and recommended precautions and procedures.

EXPRESS ASSUMPTION OF RISK AND RESPONSIBILITY: In recognition of the inherent risks of the activity which my child will be engaged in, I confirm that my child is physically and mentally capable of participation in the activity and/or using equipment. I understand that my child will be participating willingly and voluntarily and I assume full responsibility for personal injuries, accidents or illnesses, including death. I also assume responsibility for damage to or loss of personal property as the result of any accident that may occur.
On behalf of myself, my child, and any other parent of the child, I assume the risk(s) of personal injuries, accidents, and/or illnesses, including, but not limited to, sprains, torn muscles and/or ligaments; fractured or broken bones; eye damage; cuts, wounds, scrapes, abrasions, and/or contusions; dehydration, oxygen shortage (anoxia), exposure and/or altitude sickness; head, neck, and/or spinal injuries; animal or insect bite or attack; injury caused by discharge of any weapon; shock, paralysis, and/or death.

TERMINATION OF ACTIVITY: I recognize that you, as provider of services, may find it necessary to terminate any activity due to forces of nature, medical necessities, or other problems; and/or to terminate the participation of any person you judge to be incapable of meeting the rigors or requirements of participating in the activity. I accept your right to take such actions for the safety of my child and/or other participants. I acknowledge that no guarantees have been made with respect to achieving objectives.

AUTHORIZATION: I hereby authorize any medical treatment deemed necessary in the event of any injury to my child while participating in the activity. I will have appropriate insurance or, in its absence, I agree to pay all costs of rescue and/or medical services as may be incurred on behalf of my child.

RELEASE: In consideration of services or property provided, I, for myself, for my child, and for any other parent of the child, do hereby release the Muncie Family YMCA, the Muncie YMCA of Indiana Inc., Camp Crosley YMCA, its principals, trustees, directors, officers, agents, employees and volunteers, and each and every land owner, municipal and/or governmental agency upon whose property an activity is conducted, from all liability with respect to my child and I waive any claim for damage arising from any cause whatsoever, except for any claims which are the result of gross negligence of the party or parties released herein. I authorize the YMCA to take and use any photographs, slides and videos of my camper for promotional purposes, brochures, flyers, website and the internet.
 
Signature*      
Parent/Legal Guardian Signature (Camp Crosley YMCA Summer Camp Release of Liability)

Type Parent/Legal Guardian's Name of Signature Above
Type Name*   
    
 Date of Signature
Date*