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There Will Be a Late Fee of $15 for Payment After This Date
Please use Format (111)123-1234
size marked will be given first week of each session
If you check “NO” give specific instructions on this page for the camp to follow if you or the person designated cannot be located. In case of serious accident or illness, we attempt to contact you in order to explain the situation and let you decide what is to be done. Occasionally we cannot locate the individuals listed on the form. This is the reason we ask for your permission to take your child to the hospital when it seems necessary.
Children are transported to the hospital by the Mayfield Heights Fire Department Paramedics. The Paramedics cannot remain at the hospital nor bring the child back. This is your responsibility. If we cannot locate you to accompany your child, a counselor will accompany your child and the Paramedics to the hospital. Mayfield Heights Recreation does not provide insurance for campers. Each participant must provide his/her own insurance.No refunds after May 25, 2018. If a child is withdrawn from camp before camp begins, $15 will be retained by the City of Mayfield Heights to cover administrative costs.
Note: Permission is granted for my child, if registered, to take scheduled Field Trips with the camp under the supervision of the Mayfield Heights Recreation Department.
It is very important to the Mayfield Heights Day Camp Staff to know who is picking your child/children up from camp. Please list below the names of the people who have permission to pick up your child/children. If there is a day when someone other than those listed below will be picking up your child, please send a note that day and give it to your child’s counselor.The following listed people have permission to pick up my child:
By signing below you acknowledge the above provided information is accurate and complete for you camper and agree to all terms listed in the information provided including the Day Camp Handbook. As a participant in this and any other program of the Mayfield Heights Parks and Recreation Department, I, for myself or the participant for whom I sign (if under 18 years of age), recognize and acknowledge that I/we may be exposed to a variety of risks and I/we agree to assume all such risks, including but not limited to, any damage resulting from physical injuries, death, loss of services or consortium, loss or damage to property, or any other loss or injury I/we may sustain as a result of participating in any and all activities connected or associated with such programs. I acknowledge that I/we have no physical limitations, or disabilities of any kind which would restrict me/us from participating. Any special accommodations needed have been noted or will brought to the attention of the Mayfield Heights Parks and Recreation Department
In consideration of the Mayfield Heights Parks and Recreation Department accepting my/ our registration and with the intent to be legally bound, I hereby, for myself or the participant for whom I sign (if under 18 years of age) and all heirs, executors, administrators and assigns: (1) forever release, waive and relinquish any claim I/ we have or may have as a result of participating in this and all other programs of the City of Mayfield Heights Parks and Recreation Department; and (2) promise not to sue and agree to hold harmless and defend, the City of Mayfield Heights and its officers, officials, agents, employees, volunteers, independent contractors, and other representatives (referred to collectively hereinafter as “City of Mayfield Heights”) from any and all claims, liabilities, demands, actions or causes of action in any way resulting from my/our participation in this and all other programs of the Mayfield Heights Parks and Recreation Department.
Use of Photographs: I do hereby grant and give the City of Mayfield Heights the right to use my photograph or image (or the photograph or image of the participant for whom I am signing) with or without my/our names, both single and in conjunction with other persons or objects for any and all purposes including, but not limited to, private or public presentations, advertising, publicity and promotion relating hereto. I warrant that I have the right to authorize the foregoing uses and do hereby agree to hold the City of Mayfield Heights harmless of and from any and all liability of whatever nature, which may arise out of result of such uses.Please read carefully, by signing you waive certain legal rights.
Parent/Guardian (if participant is under 18 years old)
This field is not part of the form submission.
* indicates a required field