Camper Name *

First Name

Last Name

Which Session will your camper attend? *

Session 1 (July 7-11)

Session 2 (July 21-25)

Parent/Guardian Name *

First Name

Last Name

Relationship to Camper *

Parent

Relative

Legal Guardian

Phone *

(###)

###

####

Alternate Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact *

First Name

Last Name

Drop Off + Pick Up Person #1 *

First Name

Last Name

Phone *

(###)

###

####

Drop Off + Pick Up Person #2

First Name

Last Name

Phone

(###)

###

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By checking the below box, I/we hereby grant consent to any and all Health Care Provisions designated by Barton Springs Nursery. This consent includes First Aid and transportation to/ from Health Care Providers by Emergency Services.

I acknowledge the above to be true.

RELEASE OF LIABILITY FOR MINOR PARTICIPANTS *

Read Before Signing IN CONSIDERATION OF my minor child/ward listed above (“my child”), being allowed to participate in any way in the Barton Springs Nursery’s “Summer Camp at BSN” program, the undersigned acknowledges, appreciates, and agrees that: The risk of injury to my child from the activities involved in these programs is significant, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and, I myself, my spouse, my child, and on behalf of my/our heirs, assigns, personal representatives and next of kin, HEREBY RELEASE THE other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event (HEREIN AFTERWARDS REFERRED TO AS “RELEASES”), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property incident to my child’s involvement or participation in these programs which includes transporting my child to and from such programs, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law. FOR MYSELF, SPOUSE, AND CHILD, I KNOWINGLY AND FREELY ASSUME ALL RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my child’s participation; and, I willingly agree to comply with the program’s stated and customary terms and conditions for participation. If I observe any unusual significant concern in my child’s readiness for participation and/or in the program itself, I will remove my child from the participation and bring such attention of the nearest official immediately; and, I, for myself, my spouse, my child, and on behalf of my/our heirs, assigns, personal representatives and next of kin, HEREBY INDEMNIFY AND HOLD HARMLESS all the above Releasees from any and all liabilities incident to my involvement or participant in these programs, EVEN IF ARISING FROM THEIR NEGLIGENCE, to the fullest extent permitted by law. CHECKING THE BELOW BOX INDICATES; I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARY WITHOUT ANY INDUCEMENT. *

I ACKNOWLEDGE AND CONSENT.

Understanding of Risk *

For my child, I understand the seriousness of the risks involved in participating in this program, my personal responsibilities for my child adhering to rules and regulation, and fully accept them.

I ACKNOWLEDGE THE ABOVE TO BE TRUE.

Consent for Photography/Videography *

Barton Springs Nursery has my permission to use pictures and video of my child for promotional materials.

I ACKNOWLEDGE THE ABOVE TO BE TRUE.