EASTER SEAL CAMP KYSOC
CHALLENGE PROGRAM RELEASE FORM

I, _____________________ wish for my camper ___________________ to be accepted for participation in the challenge course experience at Easter Seal Camp Kysoc; in consideration that Easter Seal Camp Kysoc’s action in allowing me to participate in the experience.

I understand that the adventure experience I am requesting for my camper to participate in has certain physical risks, and dangers that may occur. These include, but are limited to, the hazards of accident, incident, or illness in remote places. I further recognize that these risks may also include loss or damage to personal property or injury due to accidents that occur, including accidents resulting from climbing, swinging, or other type of outdoor activities. I further understand that in participating in the activities my camper may be exposed to the elements of nature, including various degrees of temperature and inclement weather. I also agree that my camper will follow all rules and regulations of camp during their experience.

I have and do hereby assume all the above risks and any other ordinary risk incidental to the nature of the challenge course experience, including risks that are not specifically foreseeable and will hold Easter Seal Camp Kysoc harmless from any and all liability, actions, causes of action, debts, claims, and demands of every kind of nature whatsoever, whether for bodily injury, property damage or loss, of which my camper has now or may arise in connection with their challenge course experience by Easter Seal Camp Kysoc and staff. The terms hereof and my signature on this document shall serve as a release and assumption of risk.

Camper Name: ______________________________________________________

  Yes, I wish for my camper to participate in the Challenge Course Program.
  No, I do not wish for my camper to participate in the Challenge Course Program.

Parent/Guardian Signature________________________________________________

Date_________________ Signature of Legal Guardian_________________________
    (if applicant is under age 18)

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