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CAMP DATES: JUNE 27, 2022-JULY 29, 2022
No camp on Monday July 4th
TIMES: Typically 9:00 A.M.-3:00 P.M. UNLESS OTHERWISE ADVISED BY CAMP STAFF
LOCATION: B. MICHAEL CAUDILL MIDDLE SCHOOL
AGES: 11-14 YEARS OLD
I promise to use good language, obey the Summer Camp rules, respect property, other people, and to obey the Summer Camp Staff. I understand this is for my safety and the safety of other people. I will be respectful of others and helpful to my fellow campers during the times that we are at camp.
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
(Enter Full Name)
I hereby consent to and authorize the use and reproduction by the Richmond Police Department and the City of Richmond; or anyone authorized by these organizations, of any and all photographs or video footage that have been taken the camp participant during the Richmond Police Department Summer Camp for any marketing or promotional purposes, without compensation to me, the above named participant. All video, electronic images, together with prints, are owned by the Richmond Police Department or City of Richmond, or anyone authorized by these organizations. The Richmond Police and the City of Richmond reserve the right to use these photographs or electronics images in any of their print or electronic publications. I hereby acknowledge that I am the parent or legal guardian of the above named participant, I am 18 years of age or older and have read and understood the terms of this release.
Parent or Guardian
Please list any medical conditions your child has, including physical, behavioral, special needs, etc. Please note that this information will be kept conﬁdential:
Please complete the following regarding your child's medication and allergies:
Prescription Drug Information: (FILL OUT ONLY IF YOUR CHILD WILL BRING PRESCRIPTIONS TO SUMMER CAMP)
YES my child can sit with other children during snack/lunch/etc. who may have eaten or will eat the food(s) my child ls allergic to.
NO my child can NOT sit with other children during snack/lunch/etc. who may have eaten or will eat food(s) my child is allergic to.
I understand that the Richmond Police Department and the City of Richmond partner with the Summer Feeding Program presented by the Madison County Schools and work with local businesses who provide food to our Summer Camp. I understand that the Richmond Police Department and the City of Richmond is not responsible for the production or making of the food, nor the ingredients these locations utilize to make the food.
I hereby authorize the City of Richmond and the Richmond Police Department, its employees, and representatives, elected or appointed ofﬁcials or designee(s) to treat my child for any injury/illness that he/she sustains during participation in any designated Summer Camp Activity. I will also be sur that my child will not attend if he/she is not in good physical condition on that day. I understand that this is also for the safety of my child, other children, and the staff that is utilized by the Richmond Police Department Summer Camp. In case I can't be reached in the event of an emergency, I authorize all necessary medical treatment and admission to any hospital designated by the City of Richmond and the Richmond Police Department, its staff, employees, or designees, if advanced care (X-rays, Tests, etc.) is required. It is understood that the participants and their parents/guardians will be notified to grant authorization for any surgical procedure.
If it is necessary to contact his/her physician, the child's family doctor name and number is as follows:
WHEREAS, the City of Richmond, Kentucky (City) through its Richmond Police Department does offer the public at large the opportunity in various activities including, without limitation summer camp, golf, baseball, basketball, softball, soccer, miniature golf, volleyball, fishing, walking, cycling, swimming, batting practice in batting cages, picnics, group outings, and horseshoe pitching at the City's recreational areas; other activities to include horseback riding, scavenger hunts, trips to outdoor locations, museums/family destinations/zoos or aquariums; and
WHEREAS, the undersigned does wish to participate in one or more of such activities; and
WHEREAS, the undersigned do understand that physical activity, by its very nature, carries with it certain inherent risks that cannot be eliminated regardless of the care taken to prevent injuries and that certain of the activities in which the undersigned may participate additionally involve the use of machinery or equipment which may malfunction and which necessarily increases the risks inherent in participation in such activities; and
WHEREAS, the speciﬁc risks vary from one activity to another, but in each activity the risks may include, without limitation risks from minor injuries such as scratches, bruises, sprains, and the like, to major injuries such as loss of sight, broken bones, joint or back injuries, concussions, heart attacks, and the like, to catastrophic injuries including paralysis and death; and
WHEREAS, the undersigned have read the previous paragraphs, do fully understand their provisions, do fully understand the nature of the activities in which the undersigned may or will participate, do understand the demands of such activities relative to the undersigned’s physical condition and skill level, and do fully understand and appreciate the types of injuries which may occur as a result of the activities in which the undersigned may or will participate as made possible by the City at its said facility;
NOW, THEREFORE, the undersigned do agree and represent as follows:
1. Waiver and Release. In consideration of the permission extended by the City to use, today and on all future dates, the property, facilities and services of its recreational areas, the undersigned on behalf of their family, estate, heirs and assigns do hereby assume the risk of injury to the undersigned resulting from participation in the above described activities and do hereby release, waive, covenant not to sue, and discharge the City, its officers, employees, volunteers, agents and departments from any liability for any and all claims for personal injury or death and any claim related thereto or derived therefrom arising from or in connection with the undersigned’s participation in the various activities and facilities offered by the City at its recreational areas, including, without limitation, organized activities, summer camp, classes, observation and individual use of facilities, premises or equipment.
2. Indemniﬁcation and Hold Harmless. The undersigned do further agree to indemnify and hold harmless the City, its ofﬁcers, employees, agents and departments, as well as the facilities or staff for the Madison County Schools, from all claims of every kind and description brought against them or any of them arising from or in connection with the undersigned’s participation in the various activities and facilities offered by the City at its recreational areas as above set forth.
3. Voluntary participation. The undersigned do hereby assert and represent that the participation of the undersigned in such activities is wholly voluntary and that the undersigned do knowingly and fully assume all risks associated with such activities.
4. Knowing and Voluntary Execution. The undersigned have read this waiver of liability, indemnity & assumption of risk instrument and do fully understand its terms. They acknowledge freely and voluntarily signing this agreement and intend their signature(s) to signify a complete waiver, indemniﬁcation obligation and assumption of the risks inherent in the participation of the undersigned in such activities to the fullest extent allowed by law in the Commonwealth of Kentucky.
5. Breadth of Agreement; Severability. The undersigned do expressly agree that this instrument is intended to be as broad and inclusive as is permitted by the law of the Commonwealth of Kentucky and that if any portion hereof is held invalid, it is agreed that all remaining provisions hereof shall remain in full legal force and effect. It is further understood that the parties hereto are waiving and giving up substantial rights, including the right to compensation for personal injury or death and they do so freely and voluntarily with full knowledge of the consequences and in consideration of the agreement of the City to permit the undersigned to participate in such activities.
I hereby agree to participate or give permission for my minor child to participate in the Richmond Police Department Summer Camp and I agree to the terms listed above.
The Richmond Police Department Summer Camp strives to provide an atmosphere which is conducive to safety and appropriate behavior so that every child/parent can enjoy their camp experience. Maintaining proper conduct is a shared responsibility of campers, parents, and Richmond Police Department or its designees and staff.
All campers must sign the Child Code of Conduct, which can be found on the registration from.
1. If inappropriate behavior is observed, the child will be removed from the situation and discuss why the behavior was inappropriate. The child may be asked to sit out during an activity based on the offense.
2. On the second offense, if the behavior persists, the child may be sent home. The child may also be asked take a day off from camp to think about their actions.
3. On the third offense, the child will be dismissed from the program.
*Fighting or disrespectful behavior will not be tolerated. This may result in dismissal from the camp immediately.
*The Richmond Police Department Staff reserves the right to ask that a child not return for any reason he/she deems appropriate
*Child may not be eligible to participate in future camp sessions.
*No electronics of any kind should be brought to camp; Camp Staff are not responsible for lost or stolen items. We will be doing activities each day and use of cell phones will not be allowed.
*Shoes must remain on feet at all times. Closed-toed shoes and/or sandals with back straps are requested for safety, unless swimming.
*Each camper is responsible for helping maintain a clean and safe environment at the facility, i.e placing cups, plates, napkins, etc. in garbage.
*Each camper is responsible for their personal belongings. Richmond Police Department, Madison County Schools, or Richmond Parks and Recreation are not responsible for lost or stolen items, this includes sunscreen, towels, lunchboxes, etc.
*Foul language and violence will not be tolerated. This may result in the removal from the camp.
*No Playing on or in fountain.
*Closed shoes or sandals with back straps are requested to be worn for safety reasons. Sandals and/or ﬂip ﬂops are okay at the pool facility
*Al1 campers must remain with group at all times.
*No climbing down or jumping off of slides or on top of monkey bats. No jumping out of the swings.
*No swinging in the Handicap Accessible Swings at Lake Reba Park, which are reserved for children who have a disability.
*No playing in large feature water fountain or in drinking fountains at Lake Reba Park.
*No throwing rocks, mulch, or other objects at others or into water fountains or drinking fountains
Children must use the playground assigned to their age group.
POOL RULES- All rules posted at the pool apply.
**** Campers will NOT be able to wear their SUMMER CAMP T-SHIRT or ANY COTTON clothing while swimming at the pool. Please plan accordingly ***
*Swin1ming Days are weather-dependent.
*Please bring appropriate swim wear, towel and sunscreen,
*Partieipants must stay with buddies while swimming.
*Part-icipants must stay in designated area.
*Parcicipants must get out of the pool at every break and return to the designated camp area.
*No diving in shallow end.
Parent permission required for campers to use the diving boards and slides.
***ANY CHILD OVER 48 INCHES TALL IS ELIGIBLE TO GO DOWN THE LARGE WATER SLIDES. ***PLEASE DO NOT SEND CHILDREN IN ANY SWIMWEAR WITH METAL BUTTONS, ZIPPERS, OR RINGS IN THEIR PANTS OR THEY WILL NOT BE ALLOWED TO RIDE THE SLIDES; OR CAMP STAFF WILL REMOVE THE BUTTONS, RINGS, OR RIVETS.
*Each child must be signed in and out daily.
*Parents or Guardians must bring an ID to pick up children- DAILY. This is especially important if you have an authorized person picking up your child that the staff has not met. IDs will be checked by staff every day for the safety of all campers, EVEN FOR RETURNING CAMPERS.
*Everyone who is authorized to pick up the child must be on the Authorization List. This includes parents.*You must physically come into the school to pick up your child or to the location where the children will be no later than 3:00pm, unless enrolled in Post-Camp.
****Refusal to come and pick up your child or any neglect action will result in the contact of Department of Community Based Services (Social Services)
OTHER GENERAL CAMP RULES
*Please send appropriate clothing for the daily activity.
*If your child would like snacks or souvenirs, please send money the day of the ﬁeld trip & give to camp staff at the time of drop-off. Camp Staff are not responsible for lost or stolen money.
*Please send towels and sunscreen when required for various outings. Please label as these items are easily lost/misplaced.
*Adequate time will be given to parents if drop-of/pick-up locations change.
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