Buckeau Farm Camp Registration

Parent/Guardian Information

Emergency Information

Informed Consent and Acknowledgement

I acknowledge that participating in summer camp activities at Buckeau Farm including but not limited to interaction with animals and engagement in outdoor activities, involves inherent risk of physical injury or accident.

Inherent risks of summer camp activities include risks of injury by land, equipment, and animals, as well as the potential for my child(ren) to act in a negligent manner that may contribute to their injury, illness, or damage, or for other participants to act in a manner that may cause injury, illness, or damage.

I agree to release, discharge, and hold harmless Buckeau Farm, its owners, employees, volunteers, and agents from any and all liability for any injuries, losses, or damages arising from participation in summer camp activities.

ACT 31 WARNING: Under Vermont law, an agritourism host is not liable for the injury or death of a participant in an agritourism activity resulting from the inherent risk of the agritourism activity. Inherent risks include the risk of animals, weather, land conditions, and the potential for you as a participant to act in a negligent way that may contribute to your own injury or death. You are assuming the risk of participating in this agritourism activity.

By signing below, I acknowledge that I have read and fully understand this liability release and agree to its terms, and that I have read and understand Vermont’s Act 31.

Medical Release and Authorization

I, as the parent or guardian of the child named below, hereby authorize Buckeau Farm to seek medical treatment for my child in the event of an emergency or illness. I understand that every effort will be made to contact the child’s emergency contact before any medical treatment is sought.

I authorize the diagnosis and treatment by a qualified and licensed medical professional of the minor child in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.

This authorization is granted only after a reasonable effort has been made to reach me. Permission is also granted to Buckeau Farm and its affiliates including staff and members to provide the needed emergency treatment prior to the child’s admission to the medical facility.

I accept full responsibility for all medical costs that may arise as a result of illness or injury during camp activities.

I also agree to release, discharge, and hold harmless Buckeau Farm, its owners, employees, volunteers, and agents from any liability for any medical treatment or emergency care provided to the participant.

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.

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.