Form Instructions Thank you for signing up for REC Kids Camp! The following pages are all required. Please read through carefully, as all areas of each form must be filled out in order be considered complete. Multiple Children If you are registering multiple children, our forms allow you to place all children on the same form. You do not need to fill out multiple of the same page for each child. Form Due Dates Forms are due two (2) weeks prior to you re the camp event you are registering for. Form Expiration Date Once filled out, forms are valid for one (1) year after the signed date. Should you register for another REC Kids camp within one (1) year from the signed date, you will not need to fill out new forms. However, we may ask you to verify the information on file. Non-Summer Events Forms Due Winter Break Camp Dec. 4, 2017 President s Day Feb. 5, 2018 Spring Break Camp Mar. 12, 2018 Summer Camp Camper s first week is: Forms Due Week 1 (Jun. 4 8) May 21 2018 Week 2 (Jun. 11 15) May 29, 2018 Week 3 (Jun. 18 22) Jun. 4, 2018 Week 4 (Jun. 25 29) Jun. 11, 2018 Week 5 (Jul. 2 6) Jun. 12, 2018 Week 6 (Jul. 9 13) Jun. 25, 2018 Week 7 (Jul. 16 20) Jul. 1, 2018 Week 8 (Jul. 23 27) Jul. 9, 2018 Week 9 (Jul. 30 Aug. 3) Jul. 16, 2018 Week 10 (Aug. 6 10) Jul. 23, 2018 Please note: Campers with incomplete/missing forms will not be allowed to participate in REC Kids Camp. You do not need to submit this page. Forms may be submitted via: E-mail Fax UC Internal Mail Mail reckids@uc.edu 513-556-0601 Mailing Location: 0017 REC Kids Camp UC Campus Recreation 2820 Bearcat Way P.O. Box 210017 Cincinnati, OH 45221-0017 Should you have any questions, please feel free to contact us at 513-556-0604 or reckids@uc.edu.
Basic Info. /Media Release Camper(s) Information Child 1 Name: DOB: Gender: Grade completed by 6/4/18: Child 2 Name: DOB: Gender: Grade completed by 6/4/18: Child 3 Name: DOB: Gender: Grade completed by 6/4/18: Child 4 Name: DOB: Gender: Grade completed by 6/4/18: School(s) above camper(s) enrolled in: Home Address: _ City, State, Zip: How did you hear about REC Kids Camp? Parent/Guardian Information Parent/Guardian Name: Relationship: Day Phone: Night Phone: Cell Phone: E-mail Address: _ Parent/Guardian Name: Relationship: Day Phone: Night Phone: Cell Phone: E-mail Address: _ Emergency Contact Information (Required; Must be different than the parents/guardians listed above.) Name: Relationship: Day Phone: _ Additional Phone Number (optional): Additional Authorized Pick-Ups (In addition to parents, guardians, and emergency contacts listed above. Anyone picking up a child must have photo ID.) Media Release At various times throughout REC Kids Camp sessions, the University of Cincinnati Campus Recreation Department will take digital images, photographs, and/or videotapes of the children for educational, promotional and informational purposes for use in department-related print material and on the web. When/If your child(ren) s likeness(es) or image(s) is/are used in a publication, there will be no identifying information provided (i.e. child(ren) s name(s), personal information). Please check one: I DO give permission to the Department of Campus Recreation to publish in print, electronic, or video format the likeness or image of my child(ren). I DO NOT give permission to the Department of Campus Recreation to publish in print, electronic, or video format the likeness or image of my child(ren). Acknowledgement of Understanding By signing my name below, I hereby certify that I am the parent or legal guardian of the child(ren) listed on the Campus Recreation Camp Registration forms, and that all the information contained herein is true and accurate. I further certify that the above listed individuals may pick up my child(ren) from the Campus Recreation Camp(s). If any of the information provided on these registration forms changes, I understand that it is my responsibility to inform the Campus Recreation Staff. Parent/Guardian Signature: Parent/Guardian Name (Print): Date:
Additional Policies Please initial next to each item to acknowledge you have read and understand each term. Required Forms: Campers with incomplete or missing forms will not be permitted to participate in REC Kids Camp. Forms are due two (2) weeks prior to the first week the camper is enrolled. Deposit Policy (SUMMER CAMP): A non-refundable deposit of $40 per camper, per week, is required at the time of summer camp registration. The deposit(s) will be credited to the summer camp registration fee(s). Parents/guardians may also elect to pay a partial balance or full camp balance at the time of registration. Refund Policy: Parents/Guardians requesting a refund 14 calendar days or more prior to the camp week will be given a 100% discount minus the $40 deposit. Refunds requested inside of 14 calendar days prior to the camp week will receive a 50% refund. Refunds during the camp week will not be given. For check payments and cash payments over $80, please allow two (2) to four (4) weeks for a refund check to be mailed. Camp fees will not be reduced for partial attendance. If you will not be attending a specific week, please let us know as soon as possible, so we may accommodate for waitlist families. Payment Policy: Each week s balance must be paid in full at least two (2) weeks in advance of the camp week. Acceptable forms of payment include cash, check (made out to University of Cincinnati), debit card, and credit card (Visa, MasterCard, American Express, Discover). Supervision: There may be times when campers are supervised one-on-one by a camp staff member (i.e. being escorted throughout the building, treating an injury, etc.). These instances are limited and only occur when absolutely necessary. Outside Babysitting/Tutoring Requests Should you choose to ask a REC Kids staff member to provide care or interactions outside of camp, a waiver must be completed by both the parent/guardian and the staff member. By initialing this item, you agree to obtain this form from the website, complete, and submit prior to the staff member providing care for your child(ren). Acknowledgement By signing my name below, I confirm that I have read, understand, and agree to all terms/policies listed on this page. Parent/Guardian Signature: Date: Parent/Guardian Name (Print):
Waiver of Liability Parental Permission & Medical Authorization I know that my child(ren) is/are participating in REC Kids Camp and it can be physically challenging and that physical activity, by its very nature, carries with it inherent risks that cannot be eliminated regardless of the care taken. My child(ren) is/are medically able and ready to participate. I agree that my child(ren) must abide by any decision of the camp counselors relative to their ability to complete a camp activity. I assume all risks associated with my child(ren) s participation. Having read this waiver and knowing these facts and in consideration of my entry being accepted, I for myself, my child(ren), and anyone acting on my behalf, waive and release the University of Cincinnati and its Board of Trustees, all camp instructors and University of Cincinnati staff, their representatives and successors ( Releasees ) from all claims or liabilities of any kind arising out of my child s participation in this camp. I also agree to INDEMNIFY AND HOLD HARMLESS Releasees from any and all claims, actions, suits, procedures, costs, expenses, damages and liabilities, including attorney s fees, that result from my or my minor child(ren) s participation in or involvement with any program or activity at or associated with the CRC/FCCC and to reimburse Releasees for any incurred expenses. List all children s names: Parent/Guardian s Printed Name: Parent/Guardian Signature: Date: Medical Information Please list any food allergies that may need special consideration or attention for your child(ren). Please list any health conditions that may need special consideration or attention for each child (i.e. bee stings, medication allergies, epilepsy, diabetes, asthma, etc.) If there are any activities your child(ren) cannot participate in, please explain below. Will a camp staff member need to administer medication to your child during camp hours? Yes No *If you answered yes, please submit a medication authorization form by the required deadline. Primary Physician and Insurance Information Primary Physicians Name: If you have insurance, please complete the following: Insurance Company: Policy # Subscriber Name: Relationship: Phone: Emergency Medical Treatment and Transportation Authorization In an emergency, I hereby authorize the University of Cincinnati s Campus Recreation REC Kids Camp staff member to take (print all children s names) _ to the hospital and authorize the hospital to administer emergency treatment. The University of Cincinnati is authorized to provide the appropriate medical treatment for my child(ren) for which I shall be fully responsible. I also authorize the medical facility to release any and all information required to complete insurance claims and also authorize insurance payment directly to the medical facility. Parent/Guardian Signature: Date: Parent/Guardian Name (Print):
Climbing Wall Policies The following policies have been established by the University of Cincinnati Campus Recreation Office to ensure the fair and consistent treatment of all participants. Campus Recreation reserves the right to suspend the privileges of any individual who fails to comply with staff directives. (Please Note: this is a summary and not necessarily comprehensive) All Campus Recreation general policies must be observed. Campus Recreation climbing staff must be present in order for members to climb or be in the climbing area. All participants must read and understand the climbing rules. All participants are required to sign a policies and waiver form before being allowed to climb. The following dress code is strictly enforced: o Helmets are required for all individuals under 18 years of age o All climbers must wear a shirt while climbing/bouldering. o Climbers must wear clean athletic shoes, running shoes or climbing shoes. Boots, sandals, hard-soled shoes or bare feet are not permitted. o All hand jewelry or long necklaces must be removed. Hair must be tied back when necessary. o The following personal climbing gear is permitted: harness, climbing shoes, helmet, and chalk bag (no loose chalk). Campus Recreation is not responsible for checking personal climbing gear before use. o All pockets must be free of items (e.g., coins, keys, knives, cell phones, etc.). Climbers must be at least 5 years of age and able to fit into a child harness. Please Note: Minors (Climbers 17 years of age and younger) must have a parent s or legal guardian s signature on all forms. Climbers 13 years of age and younger must have adult supervision at all times. Climbers must be at least 15 years of age to take a belay clinic. The cost of the clinic is $30.00. ***Individuals are not eligible to take a belay clinic or belay at the wall if there is a history of epilepsy or any other condition that could alter level of consciousness. Please ask the climbing staff is you are unsure if you fit into this category. The following are prohibited in the climbing wall area: o Swinging or jumping on ropes. o Climbing into a position where you will be eye level or higher with top anchors. o Grabbing bolt hangers. Bolt hangers are for carabiner attachment only. o Food or beverage, with the exception of water in a non-breakable bottle with a lid. o Leaving personal belongings in the climbing wall area. Personal belongings must be kept in a locker. o Excessive noise. Noise must be controlled for proper safety communication. o Stepping on ropes and dropping/tossing carabiners or belay devices. Belaying Policies: o Belayers must lower climbers in a smooth and controlled manner. o BELAYERS MUST NEVER REMOVE THEIR BRAKE HAND FROM THE ROPE! o Belay from standing positions only. o Talk with other climbers and try to belay for each other. Climbing staff will belay when they can, but the main responsibility for climbing staff is safety and supervision of the climbing wall. If climbers are experienced and have training from somewhere else, the normal belay clinic and subsequent test can be waived depending upon the type and quality of experience climbers have. Climbers may be eligible to take an advanced test, talk with a staff member if interested in the advanced test. Belay tests are dependent on staff availability, but are usually offered during normal climbing hours at a cost of $5.00. A follow through figure-eight knot is required to tie in a climber. Campus Recreation requests that participants do not step under or over an active belay. Please report any unsafe wall conditions to Campus Recreation climbing staff immediately. Immediately report any injury to Campus Recreation climbing staff. The numbers of climbers at any one time may be limited to ensure proper supervision. Climbing wall staff may limit individual wall time if climbers are waiting. The Campus Recreation climbing staff reserves the right to refuse wall access for the following reasons including, but not limited to: o Individuals attempting to climb dangerously. o Individuals suspected of recent alcohol or other drug use. o Individuals who attempt to climb with unsafe or unacceptable climbing gear. To boulder, all climbing wall policies must be followed with the exception of the ability to belay. The following policies are specific to the use of the bouldering area. o Campus Recreation highly recommends the use of spotters while bouldering. It is encouraged to ask the Campus Recreation staff about proper spotting techniques. o The climber may not boulder above or below any other climbers. o Only the Campus Recreation climbing staff may switch holds if/when necessary. o Be safe, be creative, have fun! Waning: Indoor climbing does not adequately prepare anyone for the greater hazards one may meet when climbing outdoors. Climbing outdoors requires additional skills.
Climbing Wall Waiver of Liability and Assumption of Risk Form I, the undersigned, have read the above policies and realize that failure to abide by the policies can result in loss of belay card or suspension from the climbing wall. Further, I agree to participate at my own risk. Assumption of Risk: I hereby acknowledge and agree that climbing walls have inherent risks, which includes serious physical injury. As a spectator of or as participant at the University of Cincinnati (UC) CRC climbing wall, I accept and assume those inherent risks for myself or my minor child listed below, which risks include, but are not limited to: 1) Falls from the Climbing walls that result in bodily impact against the wall or the ground; 2) Injuries to individuals observing the climbing wall that result from others slipping, tripping, or falling from the wall; 3) Injuries resulting from slipping, tripping or falling from the wall; 4) Injuries resulting from being dropped to the ground during belaying or lowering; and 5) Injuries associated with failure of equipment including, but not limited to ropes, slings, harnesses, climbing hardware, anchor points, or any other part of the Climbing Wall structure. Release of All Claims and Covenant Not to Sue: In consideration of my use or my minor child s use of the UC CRC Climbing Wall, I on behalf of myself, my heirs, representatives, executers, administrators and assignees HEREBY DO RELEASE the State of Ohio, University of Cincinnati, Department of Campus Recreation, and their respective board members, officers, employees, agents, representatives and volunteers from any and all liability, claims, damages, costs, expenses, injuries, illnesses, or demands of any nature whatsoever, which I, my heirs, representatives, executors and assignees may now have, or have in the future against all of the aforementioned parties on account of personal injury, property damage, death or accident of any kind, including negligence, arising out of or in any way related to my or my minor child s use of the Climbing Wall. In consideration of my use or my minor child s use of the Climbing Wall I, the undersigned user, agree to INDEMNIFY AND HOLD HARMLESS the State of Ohio, University of Cincinnati, Department of Campus Recreation, and their respective board members, officers, employees, agents, representatives, and volunteers from any and all causes of action, claims, demands, losses, or costs of any nature whatsoever arising out of or in any way relating to my use or my minor child s use of the Climbing Wall. I have full knowledge of the nature and extent of the risks inherent in the use of the Climbing Wall and that I am voluntarily assuming these risks for either myself or my minor child. I understand that I will be solely responsible for any loss or damage, including death, I sustain or sustained by my minor child while using the Climbing Wall and that by signing this agreement I am relieving all of the aforementioned parties of any and all liability for such loss, damage, or death. I further certify that I or my minor child am/is in good health, that I or my minor child have/has no physical limitations that would preclude my/his/her safe use of the Climbing Wall and that I will consult a physician prior to participating in this activity if I or my minor child do/does not routinely participate in strenuous physical activity. I further certify that I will wear proper protective equipment and ensure that my minor child does as well, and that if I choose to use my own climbing equipment, I am assume the risk for its use as well. Receipt of Policy. I further certify that a copy of the CRC Climbing policies has been made available to me, that I have read the policies, and I agree to abide by all policies and rules of the sport, facility, and/or class as mandated by the Campus Recreation Department. Helmet Waiver. Helmets are required for all individuals under 18 years of age. However, from time to time, situations which cause exceptions to this general rule arise outside of the control of the University in which due to the personal choice of the child or that of his/her parent (e.g. hairstyle) the manufacturer s helmet will not fit or does not fit a child properly. Should such a situation arise and the UIAA approved helmet does not fit my child, I may still wish for my child to partake in the climbing wall. As such, I fully understand and acknowledge that for reasons outside of the University s control and instead due to my personal choice or that of my child (e.g. hairstyle), the manufacturer s helmets may not fit or may not fit my child properly. By signing this Agreement below, I hereby acknowledge that I understand all the risks associated with not wearing a helmet and if I voluntary choose to allow my minor child to participate in the Climbing Wall at the University of Cincinnati, I hereby waive and release UC, its officers, directors, employees and agents from any and all liability associated with my voluntary refusal to wear a safety helmet. As an adult who chooses to waive my use of a UIAA approved helmet, by signing this Agreement below, I acknowledge and agree that wearing a UIAA approved helmet may help prevent head injuries and I acknowledge and I am aware of the risks associated with not wearing a helmet. I understand that UIAA approved helmets are available to me upon request at no cost. By not wearing a safety helmet, I am refusing this critical safety precaution, against the advice of the CRC Climbing Wall and the University of Cincinnati, and hereby waive and release UC, its officers, directors, employees and agents from any and all liability associated with my voluntary refusal to wear a safety helmet. Acknowledgment of Understanding. By signing this form for either myself or my minor child, I am stating that I have read this Agreement, fully understand its terms and understand that it affects my legal rights and how it affects those legal rights. I am signing this Agreement knowingly and voluntarily, and intend for it to be a complete and unconditional release of liability to the greatest extent of the law. Climbing wall users (List all child(ren)'s name(s)): _ Parent or legal guardian s signature: Printed name: Date: