Camp Registration

Order PVSA Certificate

Please follow the registration process below. You will select which camp session at the end and then be directed to payment.

Note: Registration forms should be filled out per child.

Camper Information

Camper First Name:*
Camper Last Name:*
Camper Nickname:
Birthdate:*
Gender:*
Grade Entering In Fall 2017:*
School Last Attended:*
T-Shirt Size:*

Primary Contact Information

Primary Contact First Name:*
Primary Contact Last Name:*
Mobile Phone:*
E-mail:*
Address:*

Health Information

Does your child have chronic health concerns like asthma, diabetes, or headaches?*
Any Physical Limitations?*
Are there any behavioral medications or psychological issues of which the camp should be aware?*

Waivers & Releases

Acceptance of all Releases & Policies*
By entering my name and the date below, I give you my electronic signature.
Signature:*
Date:*

Photography and Video Release

In consideration of the acceptance for the above program, the legal Parent /Guardian or as the person with express authority from the legal Parent/Guardian (the “Parent/Guardian”) of the participant or participants, such as a minor child or children, and as an Associate, including but not limited to an employee, volunteer, chaperone, etc., in Kids Who KARE Camp, LLC’s programs agree to allow Kids Who KARE Camp, LLC and its photographers and/or videographers to photograph or videotape them participating in the programs during the general sessions and breakouts, including but not limited to the training rooms and all common areas. Kids Who KARE Camp, LLC reserves the right to use the likeness of the minor child or children participant(s) and Associates without compensation in subsequent print and/or electronic publications, promotional/marketing materials, and/or on the Kids Who KARE Camp, LLC’s website. If you do not wish for the minor child or children participant(s) or as an Associate to be photographed or videotaped at the programs, please notify us in writing before any scheduled event(s).

Publicity Waiver and Release

In consideration of the acceptance for the above program, the legal Parent/Guardian of the minor child or children or as the person who has express authority from of the legal Parent/Guardian of the minor child or children (the “Parent/Guardian”) and any other person(s) associated with Kids WhoKARE Camp, LLC, including but not limited to employees, volunteers, chaperone, etc. (“Associate”and/or “Associates”) hereby permits and authorizes Kids Who KARE Camp, LLC (the “Camp”), and its employees, agents, and representatives, as well as its affiliates, successors, and assigns, (“Authorized Persons”), to use the name, image, likeness, appearance, voice, and other personal characteristics (collectively, “Likeness”) of the minor child or children in all materials created by or on behalf of the Camp that incorporate their Likeness(“Materials”), for advertising, promotion, and any other commercial or lawful purposes, and to use and license others to use their Likeness in any medium or format whatsoever, now existing or hereafter created, including but not limited to, in and on print, video presentations, television, radio, news bulletins, mailers, brochures, billboards or signs, other print publications, website placements, video, blogs, social media, podcasts, and other digital delivery and electronic media, as well as any other advertising and promotional materials, without further consent from theParent/Guardian and Associates or any royalty, payment, or other compensation to the Parent/Guardian and/or the minor child or children and Associates.

Parent/Guardian and Associates understand and agree that the Materials will become the sole and exclusive property of the Camp. The rights granted under this release include all current and future intellectual property rights in the Materials which may contain the Likeness of the minor child or children and Associates.

Parent/Guardian andAssociates hereby irrevocably transfer and assign to the Camp the entire right, title, and interest, if any, in and to the Materials and all copyrights in the Materials arising in any jurisdiction throughout the world, including the right to register and to enforce such copyrights against infringers.

Parent/Guardian and Associates acknowledge and agree that they have no right to review or approve any Materials before they are used by the Camp, and that the Camp has no liability to them for any editing or alteration of the Materials or for any other effects resulting from the Camp’s editing, alteration, or use of the Materials. The Camp has no obligation to use the Materials or to exercise any rights given by the Agreement.

In addition, Parent/Guardian and Associates hereby waive any rights of privacy, publicity, copyright, or any similar claim or cause of action in tort, contract, or any other legal theory, associated with the minor child or children’s and/or Associates’ Likeness, as well as the right to inspect or approve the finished product wherein the minor child or children’s and/or Associates’ Likeness appears. Parent/Guardian and Associates waive any right to royalties or other compensation arising out of or related to the use of the minor child or children’s and/or Associates’ Likeness by the Camp. Parent/Guardian and Associates hereby forever release, hold harmless, and discharge the Camp from any claims, actions, demands, and/or causes of action which Parent/Guardian and/or Associates’, their heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of their estate have or may have by reason of this authorization. Parent/Guardian and Associates hereby covenants not to make or bring any such Claim against any Authorized Persons and Parent/Guardian and Associates forever release and discharge the Authorized Persons from liability under such Claims. There is no time limit on the validity of this Publicity Waiver and Release, nor is there any geographic limitation on where the Materials may be distributed.

I certify that I am 18 years of age or greater and that I am able to enter into contracts or agreements on my own behalf. I hereby consent without reservation to the terms and conditions of this Release. I have read this Release before signing below and I fully understand the contents, meaning, and impact of this Release. I certify that I am the legal Parent/Guardian of the minor child or children or I have the legal right to consent by express authority from the legal Parent/Guardian and, by signing below, I hereby consent without reservation to the terms and conditions of this Release. I have read this Release before signing below and I fully understand the contents, meaning, and impact of this Release.

Participant Agreement and Refund Policy

I verify to the best of my knowledge that everything on the registration is correct and the child is capable of such an experience. I recognize failure to disclose, falsification or deliberate omission of information will result in termination of services. I agree to pay the full balance at the time of registration. If payment is not received within 7 days of registration, I understand that my spot is not confirmed and re-registration will be required. A $50 withdrawal fee will be charged per session, per camper. Notice of withdrawal must be made in writing and received at least 30 days prior to the start of session. No refunds for the remainder of fees will be given for withdrawals made after that time. Non-attendance to camp, telephone or other verbal communication is not considered an official notice of withdrawal. No refunds or credits for missed days due to illness, personal conflict or other reasons. Camp schedules do not allow for campers to make up missed days. Fees are not refundable without a doctor’s authorized medical reason (this excludes behavioral or psychological issues). No refunds will be issued unless withdrawals are made at least 30 days prior to start of session. I understand that no refunds are given if a child leaves early because of home sickness or for disruptive behavior as determined by the Director.

I grant permission for the camper to participate in all planned program activities including trips by van or bus, understanding that competent leadership is provided. In case of accident or illness, Kids Who KARE Camp is authorized to secure emergency medical treatment. Prudent attempts will be made to contact parents immediately. I understand the related expenses for this medical attention will be (my) the camper’s responsibility. The Kids Who KARE Camp is not responsible for lost, stolen or damaged personal articles. I also authorize Kids Who KARE Camp to have and use photographs, slides, or video tapes of the camper named on this registration for promotional purposes and web site session photos (if you do not wish your child to be photographed, please check the box above). I agree to waive any claims against Kids Who KARE Camp, its staff, and volunteers for injuries or damages that may result from the conduct of other persons including participants in camp programs.

Camp Selection & Payment

Please select the camp session. If you are registering for more than one child, please complete this form for each child.

Once you click the register button, you will be redirected to a secure PayPal page to process payment. PLEASE NOTE: Your camp reservation will be held for 7 days. If payment has not been received within 7 days, your spot will no longer be reserved. You must re-register and re-confirm availability.

Before K.A.R.E. (8a.m. – 9a.m., $10 per day):
After K.A.R.E. (3p.m. – 5p.m., $20 Per Day):
Camp Session:
Camp Session (Teacher Promo):
Camp Session (Return Promo):
Camp Session (Sibling Promo):
Camp Session (KARESIB Promo):
Camp Session (Counselor Promo):