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application form

STEM ACADEMY
SUMMER CAMP

DEAR PARENT:

STEM ACADEMY FOR YOUNG KIDS SUMMER CAMPS WAIVER AND RELEASE OF LIABILITY AND NAME AND LIKENESS A PARENT, LEGAL GUARDIAN, OR EMPOWERED REPRESENTATIVE OF EACH MINOR CHILD(REN) REGISTERING TO ATTEND STEM ACADEMY FOR YOUNG KIDS SUMMER CAMPS (THE “CAMP”) MUST AGREE TO THE TERMS OF THIS WAIVER AND RELEASE OF LIABILITY AND NAME AND LIKENESS PRIOR TO THE CHILD(REN) PARTICIPATING IN THE CAMP.

I, on behalf of myself and my Child(ren), hereby acknowledge and agree that:

Name and Likeness Release:

In consideration for my child(ren) being permitted to participate in the Camp, I hereby grant permission to STEM Academy For Young Kids Camps, Omni Services LLC and each of its affiliated or subsidiary companies, their successors, agents, and assigns (“STEM Academy For Young Kids”) to utilize my child(ren)’s name, voice, and likeness (including, but not limited to, photographs and any video/audio recording of my child(ren)’s appearance at the Camp) in any and all manner and media, now known or hereafter developed, throughout the universe in perpetuity without limitation and without additional compensation or consideration, notification, or permission, unless prohibited by applicable law. I hereby waive any right that I or my child(ren) may have to inspect or approve any finished product (including, but not limited to, any camp blog, brochures, videos, slide shows, web sites, and/or other materials) or any advertising copy that may be used in connection therewith or the use to which it is applied.

I hereby warrant that I have the right to make this release on behalf of my child(ren) and that my granting this waiver and release and the rights conveyed thereby will not infringe upon the rights of any third party. I hereby assign all rights, title, and interest my child(ren) or I may have in any and all media now known or hereafter developed in which any or all of my child(ren)’s appearance, name, voice, and/or likeness have been captured in connection with the Camp to STEM Academy For Young Kids, along with full rights of assignability.

I understand and agree that any photographs and/or video/audio recordings I make of my child(ren) at the Camp shall be used solely for my and his/her/their private, noncommercial use, and that absolutely no sale, transmission, distribution, or commercial use of any such photographs and/or video/audio recordings or descriptions are permitted.

Physical Condition:

On behalf of my child(ren), I accept and assume any and all risks associated with his/her/their attendance and participation in the Camp and all related activities. I understand that my child(ren) should not attend the Camp if he/she/they are not in a healthy condition. Furthermore, I do hereby 2 STEM Academy For Young Kids verify that my child(ren), to the best of my knowledge, is free from contagious disease, is fully immunized, and is able to participate in the Camp.

Therefore, I hereby confirm that my child(ren):

Has no medical, and/or physical condition or history which would prevent him/her/them from participating in the Camp and/or endanger himself/herself/themselves or others at the Camp;
Has not been instructed by any physician to refrain from participating in the Camp; and
Is physically fit and able to participate in the Camp.

Medical Treatment:

In connection with any injury my child(ren) may sustain or illness or other medical conditions my child(ren) may experience during his/her/their participation in or attendance at the Camp, I authorize any emergency first aid, medication, medical treatment, or surgery deemed necessary by the attending medical personnel if I am not able to act on my child(ren)’s behalf.

In the event that I cannot be contacted in the event of an emergency, I further hereby grant STEM Academy For Young Kids permission to administer immediate treatment and/or take my child(ren) to a hospital emergency room via ambulance/emergency vehicle.

I further authorize the attending medical personnel to execute on my child(ren)’s behalf any permission forms, consents, or other appropriate documents relating to medical attention. I agree to assume all liability for any expenses incurred in such an emergency (transportation, hospitalization, x-rays, etc.).

I also understand and agree that STEM Academy For Young Kids will notify me if my child(ren) becomes ill during camp hours, and I will arrange to have my child(ren) picked up immediately from Camp. Further, I waive and release STEM Academy For Young Kids and its owners, officer, directors, employees, agents and independent contractors from any and all liability for personal injuries, illness, loss, or damage to property.

Camp Policies and Rules:

I understand and agree that my child(ren) must abide by the Camp policies and rules and the instructions of the Camp organizers, employees, staff, counselors, and volunteers at all times, and that my child(ren)’s failure to do so will result in his/her/their immediate dismissal from the Camp. Some of these policies, rules, and instructions are written and some are at the sole discretion of the Camp organizers, employees, staff, counselors, and volunteers; however, it is understood that all policies, rules, and instructions seek at all times to ensure the overall safety of the Camp and each of its participants.

Furthermore, should my child(ren) fail to behave in an appropriate manner, intentionally harm another participant, exhibit signs of illness, or violate any Camp policy and rule, I shall promptly retrieve my child(ren) when contacted by STEM Academy For Young Kids to do so, or, if I am unable to do so, notify STEM Academy For Young Kids of the person retrieving my child(ren) on my behalf. 3 STEM Academy For Young Kids I acknowledge and agree that no part of the tuition paid will be refunded to me should my child(ren) be dismissed from the Camp. I also understand and agree that no reduction or prorate in the tuition will be made for late arrivals, early departures, vacations, illness, or injury.

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