Swamp Explorers Registration Form

Camper's Full Name

First NameLast Name

Date of Birth

Date

Camper's age (at time of camp)

Camper's School

Grade camper will be entering

Camper Home Address

Street Address

Street Address Line 2

CityState / ProvincePostal / Zip CodeCountry

Parent/Guardian #1 Full Name

First NameLast Name

Parent/Guardian #1 Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Parent/Guardian #1 Email Address

example@example.com

Parent/Guardian #2 Full Name

First NameLast Name

Parent/Guardian #2 Email Address

example@example.com

Parent/Guardian Phone Number #2

Please enter a valid phone number.Format: (000) 000-0000.

Emergency Contact Name

First NameLast Name

Emergency Contact Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Please list any allergies or medical conditions

Special needs, dietary restrictions, or additional notes

Emergency Medical Authorization

I understand that my camper will be outside in the heat for the majority of this camp without access to air conditioning. I certify that my camper is physically able to participate in physical outdoor activities during the hot summer months.

Photo and Media Release Authorization I, the undersigned parent or legal guardian of the participant listed below, grant permission to Changing Elevations LLC, its employees, agents, and representatives to photograph, videotape, and record my child during camp activities, field experiences, and educational programs. I understand that these photographs, videos, and recordings may be used by Changing Elevations LLC for educational, informational, and promotional purposes, including but not limited to: Printed brochures and flyers Company website and blog Social media platforms Newsletters and email communications Advertising and marketing materials Presentations and displays I understand that: My child’s name will not be published without additional written consent. No compensation will be provided for the use of photographs, videos, or recordings. Changing Elevations LLC may edit, crop, reproduce, or distribute images and recordings as needed for lawful purposes. Once materials are published, Changing Elevations LLC cannot control further sharing by third parties. This authorization is voluntary and will remain in effect unless revoked in writing. Revocation will apply only to future uses and will not require the removal of materials already published. By checking below, I certify that I am the parent or legal guardian of the participant and that I have the authority to grant this permission.

Acknowledgement of Cancellation Policy I have read and understand the cancellation policy listed on the website. I understand that all sales are considered final. A 50% refund will be issued if I cancel before April 15. All cancellations after that date will result in no refund. I understand that Changing Elevations may cancel camp sessions if minimum number of campers is not reached. I understand that Changing Elevations may cancel either days or sessions due to weather or unforeseen circumstances. Any cancellations made by Changing Elevations will result in a full refund.

Acknowledgement of Behavior Policy I have read and understand the behavior policy listed on the website. I understand that my camper is expected to act in accordance with the behavior policy at all times. I understand that if my camper acts in a manner that is disrespectful or endangers themselves, campers or leaders, I am expected to retrieve my camper with no refund.

Acknowledgment of Activities I understand that my child will participate in educational activities organized by Changing Elevations LLC, which may include: Travel to off-site locations by school bus or other approved transportation. Walking on uneven terrain. Outdoor activities in parks, beaches, marshes, streams, forests, and other natural environments. Scientific investigations and specimen collection. Entering shallow water while using dip nets and other scientific equipment. Exposure to weather, insects, plants, and wildlife. I understand that participation in these activities involves inherent risks that cannot be completely eliminated. Assumption of Risk I knowingly and voluntarily assume the ordinary and inherent risks associated with my child’s participation in Changing Elevations LLC programs and accept responsibility for those risks. Parent Responsibilities I certify that: My child is physically able to participate in camp activities. I have disclosed any medical conditions, allergies, medications, or limitations that may affect my child’s participation. I understand that failure to disclose relevant medical information may increase the risk of injury. Release of Liability To the fullest extent permitted by applicable law, I release and hold harmless Changing Elevations LLC and its owners, members, officers, employees, instructors, volunteers, independent contractors, and agents from claims, demands, actions, damages, or liabilities arising from the ordinary and inherent risks associated with participation in camp activities. Nothing in this agreement shall release or limit liability for gross negligence, willful misconduct, or any liability that cannot legally be waived. Medical Authorization In the event of illness or injury, I authorize Changing Elevations LLC personnel to obtain emergency medical treatment for my child when I cannot be reached promptly. I understand that I am responsible for all costs associated with medical treatment, transportation, and related services. By checking below, I certify that I am the parent or legal guardian of the participant and that I have the authority to grant this permission.

By signing below, I certify that I am the parent/guardian of the camper and I agree to the terms and conditions listed above.

Payment

Registration

$300.00 Quantity

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Swamp Explorers Registration Form

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