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Camp in the Stacks Waiver Form

Please provide the requisite information below to complete your child’s Camp Waiver Form.

One waiver can be filled out for multiple Camp Weeks. A waiver must be filled out for EACH Camper registered!

Camper Information

Camper Name
Please Check the Camp Weeks your Camper is participating in.

Parent Guardian Information

As the Registrant's Parent/Guardian, I confirm that all of the entered information is acknowledged & accurate
Relationship
Your Name
(Partner/Work/Home) - Please Indicate
Address

Emergency Contact

Drop Off/Pick Up Information

Drop Off is between 8:50-9:00am Regular Pick up is 12pm Lunch Bunch Pick up is 1pm
(If different from Parent/Guardian, include relation to Camper)
(If different from Parent/Guardian)

Medical Information & Consent

Is your child presently being treated for an injury / illness / or taking any medication?
Does your child have any allergies or medical conditions?
By checking the below box, I/we hereby grant consent to any and all Health Care Provisions designated by the Charleston Library Society provided to my child or any necessary care as result of any injury/illness. This consent includes First Aid and transportation to/ from Health Care Providers by Emergency Services.

RELEASE OF LIABILITY FOR MINOR PARTICIPANTS

Read Before Signing

IN CONSIDERATION OF my minor child/ward listed above (“my child”), being allowed to participate in any way in the Charleston Library Society’s “CAMP in the STACKS” program, the undersigned acknowledges, appreciates, and agrees that:

  1. The risk of injury to my child from the activities involved in these programs is significant, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and, 
  2. I myself, my spouse, my child, and on behalf of my/our heirs, assigns, personal representatives and next of kin, HEREBY RELEASE THE other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event (HEREIN AFTERWARDS REFERRED TO AS “RELEASES”), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property incident to my child’s involvement or participation in these programs which includes transporting my child to and from such programs, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law. 
  3. FOR MYSELF, SPOUSE, AND CHILD, I KNOWINGLY AND FREELY ASSUME ALL RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my child’s participation; and, 
  4. I willingly agree to comply with the program’s stated and customary terms and conditions for participation. If I observe any unusual significant concern in my child’s readiness for participation and/or in the program itself, I will remove my child from the participation and bring such attention of the nearest official immediately; and,
  1. I, for myself, my spouse, my child, and on behalf of my/our heirs, assigns, personal representatives and next of kin, HEREBY INDEMNIFY AND HOLD HARMLESS all the above Releasees from any and all liabilities incident to my involvement or participant in these programs, EVEN IF ARISING FROM THEIR NEGLIGENCE, to the fullest extent permitted by law.
CHECKING THE BELOW BOX INDICATES; I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARY WITHOUT ANY INDUCEMENT.

UNDERSTANDING OF RISK

CHECKING THE BELOW BOX INDICATES; I understand the seriousness of the risks involved in participating in this program, my personal responsibilities for adhering to rules and regulation, and accept them as a participant.

CONSENT TO PHOTOGRAPHY/VIDEO/AUDIO

CHECKING THE BELOW BOX INDICATES, The Charleston Library Society has my permission to use pictures of my child for promotional materials

From the CLS

Thank you for registering your child for CAMP in the STACKS!

If you have any questions concerning this form, please call (843) 723-9912 and ask for our Programs Manager or Communications & Events Coordinator.

We are excited to have your little camper(s) exploring, learning and growing at the Charleston Libary Society.

See you Soon!