Camp Registration

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Parent Information

Please fill out the information below for the Parent/Guardian of the teen camper.

Name*

First Last

Email*

Phone*

Emergency Contact Information

Who should we contact in case of emergency?

Emergency Contact #1

Name*

First Last

Phone Number*

Emergency Contact #2

Name*

First Last

Phone

Child Abuse Reporting

Under the “Child Protection Act of 1987” (C.R.S. 19-3-301) in the Colorado Children’s Code, child care center workers are required to report suspected child abuse or neglect. The law at 19-3-304 states that if a child care worker has “reasonable cause to know or suspect that a child has been subjected to circumstances or conditions which would reasonably result in abuse or neglect shall immediately report or cause a report to be made of such fact to the co

unty department or local law enforcement agency.”

“Abuse” or “Neglect” means an act or omission in one of the following categories which threatens the health or welfare of a child: skin bruising, bleeding, tissue swelling, or death; any case in which a child is subjected to sexual assault or molestation, sexual exploitation, or prostitution; any case in which a child is in need of services because the child’s parents, legal guardian, or custodian fails to take the same actions to provide adequate food, clothing, shelter, medical care, or supervision that a prudent parent would take.

If at any time a staff member reasonably suspects child abuse, it is the responsibility of the staff member to report or to cause a report to be made of this suspicion to the local county department of social or human services at 719-687-3335 or the sheriff department. It is not staff’s role to investigate suspected abuse – only to report it. Persons who make a good faith report are immune from civil and criminal liability. Additionally, the law provides for the protection of the identity of the reporting party.

A child care worker who fails to report suspected child abuse or neglect commits a class 3 misdemeanor and will be punished as provided in section 18-1-106, C.R.S. The staff person could also be liable for damages “proximately caused thereby.”

I have read and understand the above requirements concerning my responsibility regarding child abuse reporting.

Child Abuse Reporting Adult Signature*

Sacramento Camp & Conference Center, Inc.
Covid-19 Liability Provisions (last revised 6/27/2020)

Assumption of Risk. Guest expressly understands and agrees that Guest’s use of Sacramento Camp & Conference, Inc. (SCCC) facilities and premises presents known and inherent risks to Guest regarding any potential and/or actual infection of Covid-19 an/or any related illness, the result of which may be both serious and minor, including but not limited to, cough, fever, pneumonia, hospitalization, and death. Guest is responsible for evaluating the risks that he or she may face. Guest has done so, and by signature below and engaging in SCCC activity, in exchange for the opportunity to voluntarily participate in SCCC and SCCC activity, has assumed the risks and is responsible for his or her actions.

Guest further recognizes, understands, and agrees that SCCC assumes no responsibility for any liability, damage, or injury relating to or resulting from Covid-19 that may be caused by the negligent, grossly negligent, or willful acts or omissions committed prior to, during, or after use of SCCC’s facilities and premises by Guest.

Acknowledgment of Safety Measures to be Utilized by Guest and SCCC. SCCC hereby acknowledges that it will seek to take certain safety measures to help prevent, as best it reasonably can, infection or spread of Covid-19. Such safety measures include the following: cleaning and disinfecting publicly used spaces, equipment, wearing gloves when cleaning and disinfecting, maintaining social distancing from Guest (Guests), its employees, visitors, and guests, and wearing face masks when in the company of Guests. SCCC will also stay apprised of any recommendations of the CDC and will consider action accordingly. Further, SCCC may remove any safety measures listed herein once the CDC or the United States, state, or local governments deem such measures are no longer necessary.

Guest acknowledges that he/she will also take certain safety measures to help prevent, as best it reasonably can, infection or spread of Covid-19 prior to entrance onto or use of SCCC’s facilities and premises, maintaining social distancing, and proper use of face masks when in the company of others. In the event that the CDC recommends additional safety measures, Guest agrees to
pursue utilization of such safety measures upon verbal or written request of SCCC.

Indemnification and Hold Harmless. Guest specifically understands that he/she is personally responsible for their actions and omissions, and any resulting sicknesses or injuries relating to or resulting from Covid-19 and agrees to indemnify, defend, and hold harmless, including from reasonable attorneys’ fees and/or any other associated costs, SCCC and its predecessors, successors assigns, officers, directors, trustees, faculty, employees, volunteers, agents, and legal representatives, from any and all actions, claims or demands that Guest, and assigns, have or may have for any and all sickness or injuries relating to or resulting from Covid-19, Guest may suffer or sustain, regardless of cause or fault, as a result of his/her voluntary decision to utilize the

facilities and premises of SCCC, caused by any act or omission of SCCC and/or Guest, its employees, visitors, and guest resulting from utilizing the facilities and premises of SCCC.

WAIVER OF CLAIMS. In consideration of being allowed to utilize SCCC’s facilities and premises, Guest (referred to herein as “Releasor”), hereby waives any and all claims, demands, damages, actions, or suits, in law or in equity, whether heretofore or hereafter accruing, or whether now known or not known to the parties, which may arise from any a negligent or grossly negligent act or omission of SCCC, or its predecessors, successors, assigns, officers, directors, trustees, faculty, employees, volunteers, agents, or legal representatives (collectively referred to herein as “Releasees”), including but not limited to claims for negligence, gross negligence, personal injury, and mental anguish, for or because of anything done or omitted, or suffered to be done, directly or indirectly related to Guest’s use of and entrance upon SCCC’s facilities and premises relating to or resulting from possible or actual exposure to Covid-19. Releasor further waives any and all liability or Releasees for their negligence or gross negligence causing any accident, illness, injury, loss or damage to personal property, or any other consequences arising or resulting directly or indirectly from Guest’s use of and entrance upon SCCC’s facilities and premises. Releasor acknowledges and agrees that Releasees assume no responsibility for any liability, damage, or injury that may be caused by the negligent, grossly negligent, or willful acts or omission committed prior to, during, or after Guest’s use of and entrance upon SCCC’s facilities and premises. By signing this agreement Releasor is giving up legal rights.

Guest Name*

Guest Signature*

Date*

Phone Number*

Email*

Name Of Group attending SCCC*

Activity Waiver

The following is a release of liability for the camp we are going to in New Mexico. If you would like a printed version, please contact us and we will provide one for you. Otherwise, the text below serves as the legally binding release of liability for Sacramento Camp and Conference Center, Inc.:

Sacramento Camp and Conference Center Inc. Adventure Activities:
Release of Liability and Indemnity Agreement

All PARTICIPANTS/PARENT/GUARDIAN, BY SIGNING HIS/HER NAME AT THE BOTTOM OF THIS RELEASE, AGREES THAT FOR AND IN CONSIDERATION OF THE OPPORTUNITY TO BE AROUND AND/OR PARTICIPATE IN “ADVENTURE PROGRAMMING”, PROVIDED BY SACRAMENTO CAMP AND CONFERENCE CENTER, INC. (HEREINAFTER CALLED “RELEASED PARTY”) HEREBY AGREES TO PAY FOR SUCH PARTICIPATION (IF REQUIRED), AND FURTHER AGREES AS FOLLOWS:

(1) THAT RELEASED PARTY, ITS AGENTS, SERVANTS, OR EMPLOYEES, HAVE EXPLAINED TO ME THAT THE RELEASED PARTY’S DUTY TO THE PUBLIC REQUIRES THEM TO DESCRIBE THE NATURE OF THIS SERVICE PERFORMED HERE IN PROVIDING ADVENTURE RELATED ACTIVITIES FOR MY USE, THAT I CLEARLY UNDERSTAND THE FAIRNESS AND MEANING OF THIS RELEASE AGREEMENT, & I ACKNOWLEDGE THAT I HAVE BEEN GIVEN AN OPPORTUNITY TO ASK ANY QUESTIONS CONCERNING THIS MATTER;

(2) THAT I KNOW & UNDERSTAND THAT THESE ADVENTURE ACTIVITIES, INVOLVES SPECIFIC RISKS OF PROPERTY DAMAGE OR PERSONAL INJURY TO ME OR TO MY MINOR CHILDREN ARISING FROM ACTIVITIES RELATED TO PARTICIPATING IN THESE ADVENTURE PROGRAMS. THIS ALSO INCLUDES THE RISK THAT THE RELEASED PARTY OR ITS SERVANTS, AGENTS OR EMPLOYEES MAY ACT NEGLIGENTLY IN SELECTING, PREPARING OR MAINTAINING THE EQUIPMENT OR PREMISES, IN ASSISTING ME OR MY MINOR CHILDREN TO PARTICIPATE IN, MOUNT, DISMOUNT, LOAD, CLIMB, ETC FROM THE EQUIPMENT, APPARATUS, HORSE OR HORSE-DRAWN VEHICLE, OR IN OTHERWISE SUPERVISING THE ACTIVITIES: BUT THAT I NEVERTHELESS INTENTIONALLY AGREE TO ASSUME THESE RISKS;

(3) I, FOR MYSELF AND/OR ON BEHALF OF MY CHILD OR LEGAL WARD, HAVE BEEN FULLY WARNED AND ADVISED BY RELEASED PARTY. THAT WHEN REQUIRED, WE WILL WEAR PROPERLY FITTED SAFETY EQUIPMENT OR CLOTHING SUCH AS CLOSED TOED SHOES, GLOVES, GOGGLE, ETC. OR HELMET IN ORDER TO REDUCE SOME OR ALL OF POTENTIAL INJURIES AS THE RESULT OF A FALL OR ANY OTHER OCCURRENCE ASSOCIATED WITH THIS HAZARDOUS ACTIVITY. WE REALIZE THAT WE ARE SUBJECT TO INJURY FROM THESE ACTIVITIES TO WHICH WE ARE EXPOSING OURSELVES PURELY VOLUNTARILY.

(4) I HEREBY DECLARE THAT I OR MY CHILD IS PHYSICALLY FIT. I OR MY CHILD DO NOT, AND HAVE NOT, SUFFERED FROM ANY OF THE FOLLOWING CONDITIONS, WHICH I UNDERSTAND MAY LEAD TO A DANGEROUS SITUATION WITH REGARD TO OTHER PERSONS OR MYSELF DURING ADVENTURE ACTIVITIES: PREGNANCY, EPILEPSY, SEIZURES,

(5) SEVERE HEAD INJURY, RECURRENT BLACKOUTS OR GIDDINESS, DISEASE OF THE BRAIN OR NERVOUS SYSTEM, HIGH BLOOD PRESSURE, LUNG OR HEART DISEASE, RECURRENT WEAKNESS OR DISLOCATION OF ANY LIMB, DIABETES, MENTAL ILLNESS, DRUG OR ALCOHOL ADDICTION, RECENT BACK INJURY, ARTHRITIS AND SEVERE JOINT SPRAINS, CHRONIC BRONCHITIS, ASTHMA, RHEUMATIC FEVER, THYROID, ADRENAL OR OTHER GLANDULAR DISORDER, RECENT BLOOD DONATION OR ANY OTHER CONDITION THAT REQUIRES THE REGULAR USE OF DRUGS, I HEREBY DECLARE THAT I HAVE NO PHYSICAL OR MENTAL CONDITION THAT SHOULD PRECLUDE ME FROM PARTICIPATING IN MY CHOSEN ACTIVITY, THAT I AM NOT PARTICIPATING AGAINST MEDICAL ADVICE OR TREATMENT AND THAT I HAVE NOT BEEN DIAGNOSED BY A REGISTERED DOCTOR AS HAVING A TERMINAL ILLNESS. I FURTHER DECLARE THAT IN THE EVENT THAT I FEEL ILL OR UNWELL, HAVE ANY PHYSICAL COMPLAINTS WHATSOEVER OR IF AN INJURY IS SUSTAINED OF ANY KIND DURING THE COURSE OF ADVENTURE ACTIVITIES, I WILL NOTIFY THE FACILITATOR/EMPLOYEE OF THE INSURED IMMEDIATELY AND BEFORE MOVING AWAY FROM THE IMMEDIATE VICINITY.

(6) THAT I HEREBY RELEASE AND FOREVER DISCHARGE RELEASED PARTY, ITS AGENTS, SERVANTS OR EMPLOYEES FROM ALL PRESENT AND FUTURE CLAIMS ARISING FROM PERSONAL INJURY OR PROPERTY DAMAGE SUSTAINED BY ME OR BY MY MINOR CHILDREN DURING THE USE OF THE PROPERTY, EQUIPMENT, ATV, HORSE OR HORSE-DRAWN VEHICLE, AND ALL OTHER RELATED EQUIPMENT OF RELEASED PARTY, WHETHER OR NOT LOSS, DAMAGE OR INJURY RESULTED FROM THE NEGLIGENCE OF RELEASED PARTY OR ITS AGENTS, SERVANT OR EMPLOYEES AND RELEASED PARTY’S FAILURE TO USE DUE CARE, EITHER IN ITS TRAINING METHODS OR IN ITS FURNISHING SAFE EQUIPMENT, AND I SHALL ASSUME ALL RISKS RELATED TO BEING AROUND OR OBSERVING ACTIVITY PROGRAMMING, SHOOTING SPORTS, ATVS, HORSES, HORSEBACK RIDING OR RIDING HORSE-DRAWN VEHICLES, ETC.

(7) THAT I WAIVE MY RIGHT TO FILE AND PROMISE NOT TO FILE ANY LEGAL PROCEEDINGS AGAINST RELEASED PARTY, ITS AGENTS, SERVANTS OR EMPLOYEES, FOR ANY PERSONAL INJURY OR PROPERTY DAMAGE SUSTAINED BY ME OR BY MY MINOR CHILDREN DURING THESE OR ANY ACTIVITY, INCLUDING DAMAGE ARISING OUT OF NEGLIGENCE BY RELEASED PARTY, ITS AGENTS, SERVANTS OR EMPLOYEES; AND I SHALL PAY ALL COSTS AND ATTORNEYS’ FEES FROM ANY LEGAL PROCEEDINGS WHICH I MAY BRING CONTRARY TO THIS AGREEMENT AND WHICH IS RESOLVED IN FAVOR OF RELEASED PARTY, ITS AGENTS, SERVANTS OR EMPLOYEES;

(8) WHERE APPLICABLE I WILL READ ALL RULES AND REGULATIONS POSTED, HANDED OUT, OR VERBALLY EXPLAINED TO ME OR MY CHILD AND ABIDE BY THOSE RULES AND REGULATIONS

(9) IF PARTICIPATION IN EQUESTRIAN ACTIVITY: THAT I SIGN THIS RELEASE AGREEMENT FOR AND IN CONSIDERATION OF THE AGREED PRICE, AND I HEREBY REQUEST RELEASED PARTY, ITS AGENTS, SERVANTS OR EMPLOYEES, TO CHOOSE FOR ME OR FOR MY MINOR CHILDREN A HORSE OR HORSE-DRAWN VEHICLE, FOR THE PURPOSE OF BEING AROUND HORSES OR RIDING SAME, KNOWING THAT RELEASED PARTY, ITS AGENTS, SERVANTS, OR EMPLOYEES ARE RELYING UPON THIS RELEASED AGREEMENT AND THE INFORMATION THAT I HAVE GIVEN TO THEM CONCERNING MY EXPERIENCE AND THAT OF MY MINOR CHILDREN WITH HORSES AND HORSE-DRAWN VEHICLES, INCLUDING THE POTENTIAL HAZARDS INVOLVED;

WARNING
UNDER NEW MEXICO LAW, AN EQUINE ACTIVITY SPONSOR OR AN EQUINE PROFESSIONAL IS NOT LIABLE FOR AN INJURY TO OR THE DEATH OF A PARTICIPANT IN EQUINE ACTIVITIES RESULTING FROM THE INHERENT RISKS OF EQUINE ACTIVITIES, PURSUANT TO NEW MEXICO STATUTES 42-13

(10) THAT I HAVE READ THE FOREGOING RELEASE, AND BEING OF SOUND MIND AND AN ADULT, SIGN IT FREELY WITH FULL KNOWLEDGE OF ITS MEANING AND CONTENT.

(11) THIS RELEASE FORM COVERS THE FOLLOWING ACTIVITIES ALL ACTIVITIES INCLUDE BUT MAY NOT BE LIMITED TO: ARCHERY, ARCHERY TAG, SLIP N SLIDE, SHOOTING SPORTS (.22 RIFLE, TRAP, SKEET, FIREARM SAFETY, HANDGUN INSTRUCTION, OPEN RANGE, BB GUNS,) KNIFE THROWING, CHALLENGE COURSE (INDOOR/OUTDOOR, ZIP LINE, GIANT SWING, ETC.), PAINTBALL, POCKET SHOT PAINTBALL, LASER TAG, RC CARS/BOATS, FLING THING, ATV RIDING, MOUNTAIN SCOOTERS, PEDAL CARTS, PADDLE BOATS, ROLLER/ICE SKATING, SNOW SLEDDING,(AND OTHER WINTER SPORTS), FISHING, HIKING, SEMINARS, GYM/SPORTS FIELD ACTIVITIES, CAMP OUTS, CAMPFIRES, AND ALL HORSE ACTIVITIES (RIDING/WAGON RIDES/EQUINE THERAPY/ROUND PEN DEMOS)

If ATV activity check level of riding ability:*

Good

Fair

Poor

If HORSE RIDING activity check level of riding ability:*

Good

Fair

Poor

Participant Name*

First Last

Participant Date of Birth*

Participant Signature*

Date*

Parent or Legal Guardian Name*

First Last

(If participant is under the age of 18.)

Parent Signature*

Date*

Please use remainder of this form for listing additional dependent minor children. Printed name and DOB needed on these as well.*

73853

Camper Info

Parent Information

Emergency Contact Information

Child Abuse Reporting

Medication Form

Allergies, Over-the-Counter & Prescription Medication Information

Nurse Administered Over-the-Counter Medicine

Camper’s Prescription Medicines & Medication Policy:

Sacramento Camp & Conference Center, Inc.
Covid-19 Liability Provisions (last revised 6/27/2020)

Activity Waiver

Payment

CONTACT US