Spring Break Camp Registration

Statement of Understanding:

I (parent/guardian/caregiver of the registered camper) hereby make application to enroll my child in Peak Potential Therapy LLC's camp program. I hereby certify that my child is of good moral character. For a safe and fun environment, participants are expected to behave in an acceptable manner and use appropriate language. We encourage kindness and positivity! Aggression or bullying is not tolerated. It is important to remember there are no refunds if a participant is asked to leave the program due to unacceptable behavior. I hereby also certify that I have given full disclosure concerning all medical, physical, and psychological conditions which might have relevance to the performance of my child. I also understand that I am liable for information that is false, misleading, or later found to be omitted concerning all such medical, physical, or psychological conditions and all suspensions, expulsions, or adjudications. I have no objection to publicity in conjunction with camp activities that involve my child.

Payment & Refund Policy:

I (parent/guardian/caregiver of the registered camper) hereby certify that I will assume the necessary financial obligations. I understand that my child’s camp spot being reserved by making this application is not held until the deposit of $100.00 per registered camp week has been received and paid. The deposit will be credited as partial payment towards the last registered camp week and will be refundable only if notified in writing of camper’s withdrawal prior to March 1st. Cancellations made after this time are nonrefundable, as materials and camp staff costs are allocated and final. As long as there is availability, I’m given the ability to switch my child’s camp attendance to another week. I agree to pay the balance of camp fees upon drop off on the first day of camp. I understand and agree that no deductions or rebates will be made if the camper is withdrawn after the start of camp, and no refunds of any kind will be provided if the camper fails to report to the program.

Field Trip Permission:

I (parent/guardian/caregiver of the registered camper) give my permission for my child to participate in field trips during the regular camp day, supervised by staff.

Emergency Treatment Authorization:

I (parent/guardian/caregiver of the registered camper) hereby authorize the diagnosis and treatment a qualified and licensed medical professional, of my child, should a medical emergency occur, which the attending medical professional believes requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement or impairment, or undue pain, suffering or discomfort if delayed. In the event of a medical emergency, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. The authorization is granted only after a reasonable effort has been made to reach me. Permission is also granted to Peak Potential Therapy LLC and its affiliates to provide emergency treatment prior to the child’s admission to the medical facility. This release is authorized for the duration of the registered session. This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.

Liability Hold Harmless Agreement Waiver:

I (parent/guardian/caregiver of the registered camper) hereby understand that Peak Potential Therapy LLC takes reasonable precautions to ensure that Peak Potential Therapy LLC’s camp program and activities are conducted by qualified personnel in a safe and responsible manner. I hereby acknowledge and agree that there is the possibility of physical injury or loss associated with my child’s participation in the program and hereby release, hold harmless, indemnify, and discharge Peak Potential Therapy LLC, its affiliated organizations, employees, and associated personnel including the owners of the program and program facility against any and all claims, liabilities, costs, and/or damages deriving from my child’s participation in the program, whether arising from an act or omission, negligent or otherwise, to the fullest extent permitted by law. I understand that any fees charged for the program do not include accident or personal insurance. I recognize these risks and agree to accept these risks by allowing my child to attend Peak Potential Therapy LLC’s camp and participate in these programs. Permission is granted for my child to participate, and I understand that by signing this form I am voluntarily and knowingly accepting responsibility for my child's participation in all Peak Potential Therapy LLC’s camp activities.

CONFIRMATION:

I (parent/guardian/caregiver of the registered camper) hereby acknowledge having read, understand, and agree to the Terms & Conditions of the program, which is required for my child to participate. By signing this form, I give Peak Potential Therapy LLC permission to debit my account the total amount due as indicated on the camp fee schedule.