Name of Parent/Guardian
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First Name
Last Name
Relation to Child
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Phone
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Address
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Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Email
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Name of Camper
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First Name
Last Name
Nickname or Preferred Name
First Name
Last Name
Birthdate
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MM
DD
YYYY
Which camps are you enrolling in today?
T-Shirt Size
Emergency Contact
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First Name
Last Name
Emergency Contact Phone Number
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Emergency Contact Relationship to Child
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Please list any allergies, medications, medical, or health conditions of which we should be aware:
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First and Last Names of all persons authorized for camper pick-up (including yourself):
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Do you consent to have photos of your child and/or their artwork displayed on our website and/or social media?
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Are there any learning or personal goals we can help your camper with?
What else would you like us to know about your camper?
By submitting this form, I acknowledge that I have read, understood, and agreed to the following policies, waivers, and requests. Lunch is not provided. Please send your camper with lunch, snacks, and a water bottle each day. We will be playing, creating, and moving! Campers should dress accordingly. This camp is located at 825 Ronan St., Missoula MT, 59801. Drop-off for full day camp is any time after 7:30 am. Drop off for half day camp is 9:00 am or later. Pick up for half day camp is at 3:00 pm. Pick-up for full day camp is any time before 5:30 pm. Our schedule is flexible each day, and registered parents/guardians are welcome to visit anytime! All of our summer camp programs run Monday through Friday. Because space is limited, we do require a completed intake form and full payment at the time of registration. Cancellations before 14 days prior to the start of camp are fully refundable. Cancellations within 14 days before the first day of camp may incur a $75 fee. Tardiness in pick-up may also result in additional fees or expulsion from our program. Refunds will not be given in these circumstances. Campers and parents/guardians may also be discontinued from our programs without refund for any of the following behaviors: physical, verbal, or emotional abuse of another camper or staff member, inappropriate behavior, inappropriate conduct, or failure to adhere to our policies and procedures. Removal from our programs for these types of activities will not result in a reimbursement of funds. Our organization reserves the right to cancel a program or part of a program in the event of an emergency or if the minimum registration of 4 campers per week is not met. If an entire program, scheduled day, or event must be canceled, arts and movement summer camp LLC will give a refund in proportion to the cancellation of that program. In addition, our organization will give as much advance notice to parents/guardians as possible in those circumstances. arts and movement summer camp LLC is a day camp program. They are not a regular childcare or day-care facility and do not operate as such. WAIVER AND RELEASE OF LIABILITY IN CONSIDERATION OF the risk of injury that exists while participating in SUMMER CAMP (hereinafter the "Activity"); and IN CONSIDERATION OF my desire to participate in said Activity and being given the right to participate in same; I HEREBY, for myself, my heirs, executors, administrators, assigns, or personal representatives (hereinafter collectively, "Releasor," "I" or "me", which terms shall also include Releasor's parents or guardian if Releasor is under 18 years of age), knowingly and voluntarily enter into this WAIVER AND RELEASE OF LIABILITY and hereby waive any and all rights, claims or causes of action of any kind arising out of my participation in the Activity; and I HEREBY release and forever discharge ART AND MOVEMENT SUMMER CAMP LLC, located at PO Box 1152, Missoula, Montana 59806, their affiliates, managers, members, agents, attorneys, staff, volunteers, heirs, representatives, predecessors, successors and assigns (collectively "Releasees"), from any physical or psychological injury that I may suffer as a direct result of my participation in the aforementioned Activity. I AM VOLUNTARILY PARTICIPATING IN THE AFOREMENTIONED ACTIVITY AND I AM PARTICIPATING IN THE ACTIVITY ENTIRELY AT MY OWN RISK. I AM AWARE OF THE RISKS ASSOCIATED WITH PARTICIPATING IN THIS ACTIVITY, WHICH MAY INCLUDE, BUT ARE NOT LIMITED TO: PHYSICAL OR PSYCHOLOGICAL INJURY, PAIN, SUFFERING, ILLNESS, DISFIGUREMENT, TEMPORARY OR PERMANENT DISABILITY (INCLUDING PARALYSIS), ECONOMIC OR EMOTIONAL LOSS, AND DEATH. I UNDERSTAND THAT THESE INJURIES OR OUTCOMES MAY ARISE FROM MY OWN OR OTHERS' NEGLIGENCE, CONDITIONS RELATED TO TRAVEL TO AND FROM THE ACTIVITY, OR FROM CONDITIONS AT THE ACTIVITY LOCATION(S). NONETHELESS, I ASSUME ALL RELATED RISKS, BOTH KNOWN AND UNKNOWN TO ME, OF MY PARTICIPATION IN THIS ACTIVITY. I FURTHER AGREE to indemnify, defend and hold harmless the Releasees against any and all claims, suits or actions of any kind whatsoever for liability, damages, compensation or otherwise brought by me or anyone on my behalf, including attorney's fees and any related costs. I FURTHER ACKNOWLEDGE that Releasees are not responsible for errors, omissions, acts or failures to act of any party or entity conducting a specific event or activity on behalf of Releasees. In the event that I should require medical care or treatment, I authorize art and movement summer camp LLC to provide all emergency medical care deemed necessary, including but not limited to, first aid, CPR, the use of AEDs, emergency medical transport, and sharing of medical information with medical personnel. I further agree to assume all costs involved and agree to be financially responsible for any costs incurred as a result of such treatment. I am aware and understand that I should carry my own health insurance. I FURTHER ACKNOWLEDGE that this Activity may involve a test of a person's physical and mental limits and may carry with it the potential for death, serious injury, and property loss. I agree not to participate in the Activity unless I am medically able and properly trained, and I agree to abide by the decision of the art and movement summer camp LLC official or agent, regarding my approval to participate in the Activity. I HEREBY ACKNOWLEDGE THAT I HAVE CAREFULLY READ THIS "WAIVER AND RELEASE" AND FULLY UNDERSTAND THAT IT IS A RELEASE OF LIABILITY. I EXPRESSLY AGREE TO RELEASE AND DISCHARGE art and movement summer camp LLC AND ALL OF ITS AFFILIATES, MANAGERS, MEMBERS, AGENTS, ATTORNEYS, STAFF, VOLUNTEERS, HEIRS, REPRESENTATIVES, PREDECESSORS, SUCCESSORS AND ASSIGNS, FROM ANY AND ALL CLAIMS OR CAUSES OF ACTION AND I AGREE TO VOLUNTARILY GIVE UP OR WAIVE ANY RIGHT THAT I OTHERWISE HAVE TO BRING A LEGAL ACTION AGAINST art and movement summer camp LLC FOR PERSONAL INJURY OR PROPERTY DAMAGE. To the extent that statute or case law does not prohibit releases for ordinary negligence, this release is also for such negligence on the part of art and movement summer camp LLC, its agents, and employees. I agree that this Release shall be governed for all purposes by Montana law, without regard to any conflict of law principles. This Release supersedes any and all previous oral or written promises or other agreements. In the event that any damage to equipment or facilities occurs as a result of my or my family's or my agent's willful actions, neglect or recklessness, I acknowledge and agree to be held liable for any and all costs associated with any such actions of neglect or recklessness. THIS WAIVER AND RELEASE OF LIABILITY SHALL REMAIN IN EFFECT FOR THE DURATION OF MY PARTICIPATION IN THE ACTIVITY, DURING THIS INITIAL AND ALL SUBSEQUENT EVENTS OF PARTICIPATION. THIS AGREEMENT was entered into at arm's-length, without duress or coercion, and is to be interpreted as an agreement between two parties of equal bargaining strength. All parties agree that this agreement is clear and unambiguous as to its terms, and that no other evidence shall be used or admitted to alter or explain the terms of this agreement, but that it will be interpreted based on the language in accordance with the purposes for which it is entered into. In the event that any provision contained within this Release of Liability shall be deemed to be severable or invalid, or if any term, condition, phrase or portion of this agreement shall be determined to be unlawful or otherwise unenforceable, the remainder of this agreement shall remain in full force and effect. If a court should find that any provision of this agreement to be invalid or unenforceable, but that by limiting said provision it would become valid and enforceable, then said provision shall be deemed to be written, construed and enforced as so limited.
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