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Please Bill My *
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For Total of All Camp Fees |
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For Total of All Required Camp Deposits |
| If paying deposit only, please
select one of the following payment plans: |
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No Payment Plan |
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Invoice me for the remainder of total fees in March |
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Charge my credit card monthly *
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Equal payments thru April 2012 - if enrolling after March 1st - we will contact you for payment arrangements.
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| Card No.*
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CVV
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| Cardholder Name* |
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| Expires* |
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Credit Card Billing Information the same as the Person Financially
Responsible Information. Otherwise please complete the fields below. |
| Card Billing Address* |
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| Card Billing City* |
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| Card Billing State* |
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| Card Billing Zip* |
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| Person financially
responsible for camper*: |
| Name* |
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| Phone* |
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| Address* |
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| City* |
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| State* |
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| Zip* |
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| Relationship to camper:*
mother
father
guardian
other
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Cancellation policy/agreement:
I hereby apply for my child to attend Camp Manito-wish
YMCA. Enclosed you will find the required deposit
which I understand will be credited toward the camp
fee if my child is accepted for enrollment. I agree
to pay the total camp fee on or before April 30, 2012.
I understand that in
the event of cancellation:
- Before February 1, Camp
Manito-wish will retain 25% of the full deposit.
- Between February 1 and
June 1, Camp Manito-wish will retain the full deposit.
- In the event of cancellation
on or after June 1, dismissal due to misconduct,
or withdrawal due to homesickness, Camp Manito-wish
will retain 100% of the session fee. If a medical
condition (confirmed by a physician) occurs, Manito-wish
will retain $100 and refund the pro-rated balance.
I understand the terms covering payment of camp
fees and hereby give my approval and consent to
the application.
Photo/image-use information:
I hereby give permission to use any video,
photographs, or written statements from my child's
experience in public relations materials including
the internet without compensation.
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I have read the above Cancellation and Photo Information and agree
to all the terms* |
Camp Manito-wish YMCA
OUTPOST PARTICIPANT AGREEMENT (INCLUDING
ASSUMPTION OF RISKS AND AGREEMENTS OF RELEASE AND
INDEMNITY)
Please read this document carefully.
It must be signed by all participants. Participants
includes adults and minor participants, unless indicated
otherwise. If the participant is a minor, at least
one parent or guardian (referred to below as Parent)
must also sign, as evidence of Parents acknowledgment
and agreement to the following, on Parents
behalf and on behalf of the minor participant. Participant
and parent must determine the age of legal competency
to sign contracts, in the state of the participants
residence.
Activities and Risks
I understand that Camp Manito-wish YMCA, Inc. (Manito-wish)
participants live, camp and travel out of doors. Activities
vary from program to program and include, among others,
hiking and backpacking through mountainous and other
terrain, whitewater canoeing, sea kayaking, fishing
and portaging. I further understand and acknowledge
that the activities of the programs have risks, including
certain risks which are inherent. Inherent risks are
those which cannot be eliminated without destroying
the unique character of the activities. The same elements
that contribute to the unique character of these activities
can cause loss or damage to equipment, accidental
injury, illness, or, in extreme cases, permanent trauma,
disability or death. The following describes some,
but not all, of the inherent risks of Manito-wish
activities:
- Manito-wish activities may be strenuous both
physically and emotionally.
- Manito-wish programs usually occur in remote
places. They occur on lands open to the public,
and exposed to the acts of persons not associated
with Manito-wish. The remote locations may be many
days from medical facilities. Communication and
transportation are difficult and evacuations and
medical care may be significantly delayed.
- Equipment may fail or malfunction.
- Meals are prepared over gas stoves and open fires.
Water may require purification before use. Participants
with food allergies or sensitivities may come in
contact with offending food types. Camping risks
include burns and cuts, sprains, strains and other
injuries from slips, falls, and lifting, and illnesses
including diarrhea and flu-like illness.
- Travel is by vehicle, canoe, kayak, aircraft,
train, on foot and by other means, over improved
and unimproved roads, rugged trails and off-trail
terrain, including boulder fields, downed timber,
rivers, rapids, river crossings, high mountain passes,
snow, steep slopes, slippery rocks, ocean tides,
currents and waves. Travel risks include collision,
falling, capsizing, drowning, becoming lost, and
other risks usually associated with such travel,
including environmental risks.
- Environmental risks and hazards include flowing,
deep and/or cold water; insects, snakes, predators,
and large animals; falling and rolling rock; lightning,
flash floods, falling timber and forces or nature,
including weather which may change to extreme conditions.
Possible injuries and illnesses include hypothermia,
frostbite, immersion foot, high altitude illnesses,
sunburn, heatstroke, dehydration, and other mild
or serious conditions.
- Decisions made by the trip leaders, other staff
(including volunteers), contractors and participants
will be based on a variety of perceptions and evaluations,
which by their nature are imprecise and subject
to errors in judgment. Misjudgments may pertain
to, among other things, a participants capabilities,
environment, terrain, water and weather conditions,
natural hazards, routes and medical conditions.
- During the trip, Manito-wish cannot continually
monitor the behavior and activities of participants
and participants must accept responsibility for
themselves and others whether or not under the direct
supervision of Manito-wish staff.
- Manito-wish may from time to time use the services
of private contractors for certain tasks, including
transportation. Manito-wish is not responsible for
the acts or omissions of such contracts.
- I have read and understand the general information
about Manito-wish and its programs in the Manito-wish
brochure and/or on the Manito-wish website. The
staff of Manito-wish has been available to more
fully explain the nature and physical demands of
the activities in which I will be engaged, and certain
inherent and other risks of my Manito-wish activity.
Acknowledge and Assumption of
Inherent and Other Risks
I understand and acknowledge that the description
above (Activities and Risks) of the inherent
risks of Manito-wishs activities above is not
complete and that other, including unknown or unanticipated
risks, inherent and otherwise, may result in property
loss, injury, illness or death. I acknowledge that
my participation in this Manito-wish program is purely
voluntary, and I wish to participate in spite of and
with knowledge of the inherent and other risks involved.
I acknowledge and assume the inherent risks described
above and all other inherent risks of my Manito-wish
activity. In addition, except with respect to an injury
or other loss which occurs on lands whose rules or
regulations prohibit my doing so as a matter of law,
I expressly assume ALL risks of enrolling and participating
in a Manito-wish program, inherent or otherwise, and
whether or not described above.
Agreements of Release and Indemnity
If I am an adult participant, or the parent of a
minor participant I agree, for myself and/or on behalf
of the minor participant for whom I sign, as follows:
I hereby release, hold harmless and agree not
to sue Camp Manito-wish YMCA, Inc., its officers,
trustees, agents, and staff including employees and
volunteers (Released Parties), with
respect to any and all claims of loss or damage to
person or property by reason of injury, disability,
death, or otherwise, suffered by me or by a minor
participant for whom I sign, arising in whole or part
from my, or the minor participants, enrollment
or participation in an activity of Manito-wish.
I agree further to indemnify (indemnify
meaning to defend, and to pay or reimburse, including
costs and attorneys fees) Released Parties
against any claim by a member of my, or the minor
participants, family, a rescuer, another participant,
or any other person, arising in whole or part from
an injury or other loss suffered by me or caused by
me, or by the minor participant, in connection with
my, or the minor participants, enrollment or
participation in an activity of Manito-wish.
These agreements of Release and Indemnity include
claims of negligence of a Released Party, but not
of gross negligence or intentionally wrongful conduct.
They are intended to be enforced to the fullest extent
permitted by law. These agreements of release and
indemnity are of no force or effect with respect to
an injury or other loss which occurs on lands whose
rules or regulations prohibit such agreements as a
matter of law.
Other Provisions
If I am an adult participant or the parent of a minor
participant I further agree, for myself and on behalf
of the minor participant for whom I sign, as follows:
I have verified with my or the minor participants
physician and other medical professionals, or otherwise
satisfied Manito-wish, that I, or the minor participant,
have no past or current physical or psychological
condition that might affect my, or the minors,
participation in the program, other than as described
on the health form submitted to Manito-wish. I am,
or the minor is, able to participate without causing
harm to myself, or to himself or herself, or to others.
The medical information given to Manito-wish is accurate
and all pertinent medical conditions have been disclosed.
Prior to start of the trip, Manito-wish will be informed
of any medical condition that has not been previously
disclosed. I understand that Manito-wishs admission
of me or the minor participant is not intended as
a representation that Manito-wish staff will be able
to manage successfully a medical event or emergency
related to a disclosed, or undisclosed, medical condition.
Manito-wish reserves the right to refuse admission
or remove a participant from a trip for any reason
it deems in the best interests of the participant
or the program.
Manito-wish is authorized to obtain or provide emergency
hospitalization, surgical or other medical care for
me, or for the minor participant. I understand that
situations may arise in which third-party medical
care is not available and which require Manito-wish
staff to provide first aid and possibly more advanced
procedures, employing Wilderness First Responder training.
Such care will be provided under guidance of the Manito-wish
Consulting Physician and Wilderness Medical Associates
Wilderness Protocols. Any third-party medical care
provided is authorized to exchange pertinent medical
nformation with Manito-wish. Costs reasonably associated
with medical services, including evacuation, shall
be borne by me.
I agree to be responsible for any damage I, or the
minor participant, may cause to Manito-wish facilities
or gear. Manito-wish is not responsible for loss,
theft or damage to a participants personal belongings
stored at Manito-wish facilities.
Any dispute between me, or the minor participant,
and Manito-wish will be governed by the substantive
laws (not including the laws which might apply the
laws of another jurisdiction) of the State of Wisconsin,
and any mediation or suit shall occur or be filed
only in the State of Wisconsin.
If any of this agreement is found by a court or
other appropriate authority to be invalid, the remainder
of the agreement nevertheless will be in full force
and effect.
THE PARTICIPANT AND THE PARENT(S) OR GUARDIAN OF
A MINOR PARTICIPANT HAVE READ THIS PAGE AND THE PREVIOUS
PAGES OF THIS DOCUMENT AND UNDERSTAND AND VOLUNTARILY
AGREE TO ITS TERMS, WHICH SHALL BE BINDING UPON THEM,
THEIR HEIRS, ESTATE, EXECUTORS AND ADMINISTRATORS.
THE AGREEMENT MAY BE MODIFIED ONLY IN WRITING.
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I have read the above Waiver Information and agree to all the terms* |
| Applications are processed in the
order they are received. The session you are applying
for may be full. You will be contacted if you are placed
on a waitlist for the program of your choice. Confirmation
letters of the receipt of your application will be mailed
soon. |
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