Camp Kellogg Registration - Alaska Pacific University

Camp Kellogg Registration Summer 2024

Step 1 of 4

Photo Release Form*
As a condition of my child’s participation in the Camp Kellogg programming and activities (hereafter “Program”), I hereby grant APU and Camp Kellogg the right to use, for promotional purposes and grant applications only, any photographs of me and/or my child, including property, taken by APU or Camp Kellogg, their employees or agents, during my child’s participation in the Program. I further understand and agree that APU and Camp Kellogg may use (for marketing purposes) any statements or quotes attributed to me in my evaluation of the program.
- I agree
- I do not agree
Medical Information*
I attest that my child is physically and mentally fit to participate, including being free of symptoms of communicable disease, in the Program, and that my child does not have any medical record of history that could be aggravated by my child’s participation in the Program. I further attest I am responsible for consulting with my child’s health care provider towards this end. I acknowledge that I must be an active participant in my child’s healthcare and as such, it is my responsibility to report all injuries and illnesses, including signs and symptoms of concussions, to APU and Camp Kellogg staff. I hereby affirm that I have fully disclosed above all of my child’s prior medical conditions and will also disclose any future conditions to APU or Camp Kellogg staff. I further acknowledge that I am responsible for the cost of any and all medical and health services my child may require while participating in the Program or as a result of participating in the Program, except for medical costs arising from an injury or illness that my child sustains that is the direct result of APU or Camp Kellogg’s negligence or gross negligence or intentional misconduct. I understand and agree that APU shall not in any way be responsible for other contingent losses arising from any injury or illness my child sustains that is not the result of APU or Camp Kellogg’s negligence, gross negligence, or intentional misconduct.
- I understand and agree
Consent for Emergency Medical or Surgical Care*
I understand and agree that APU may not have medical personnel available at the location of the Program. In the event of any medical emergency, I hereby authorize and consent to any x-ray examination, anesthetic, medical, dental, or surgical diagnosis or treatment and hospital care that APU or Camp Kellogg personnel deem necessary for my child’s safety and protection. I understand and agree that APU assumes no responsibility for any injury, illness, or damage which might arise out of or in connection with such authorized emergency medical treatment. I further understand that in the event that my child experiences any condition requiring emergency medical treatment, APU may direct that my child to be transported to the hospital for such care. I understand APU and Camp Kellogg staff will make every effort to locate me or my child’s legal guardian in the event there is a medical emergency, and I further understand my obligation to keep APU and Camp Kellogg informed of my whereabouts.
- I agree
- I do not agree
Authorization to Participate*
I hereby acknowledge that my child has permission to participate in the program, including the use of APU facilities, trails, fields, grounds and all property owned and located on APU Kellogg Campus, and that my child’s participation is elective and voluntary. I agree that myself and my child will conduct ourselves in accordance with APU’s policies and procedures, and further agree to abide by all the rules and requirements of the Program. I acknowledge that APU or Camp Kellogg has the right to terminate my child’s participation in the Program if it is determined that my conduct or my child’s conduct is detrimental to the best interests of the Program or others participating in the Program; my conduct violates any rules of the Program; or at APU’s discretion.
- I understand and agree
Informed Consent*
I have been informed of and I understand the various aspects of the Program. I understand that as a participant in the Program, my child will engage in physical activities that involve or may involve inherently dangerous activities, including, but not limited to, running, hiking, skiing, snow shoeing, ice skating, dog mushing, group games, contact with poisonous insects and wild animals, inclement weather, forces of nature, negligence of others. As with any inherently dangerous activity, I understand that certain risks are inherent to personal health, safety and/or property therewith and that my child could sustain, including, but not limited to, serious bodily injuries including serious injury to virtually all bones, joints, muscles, and internal organs, cardiac problems, brain damage, illness, damage, or even death as a consequence of my child’s participation in the Program, and that protective equipment or preventative measures may be inadequate to prevent serious injury. These serious personal injuries and possible death may not only be a consequence of APU’s actions, inactions, negligence, or fault, but also the actions, inactions, negligence, or fault of others, conditions of equipment used, facility conditions, weather conditions, negligent first aid operations and procedures, and other risks not known to me or not reasonably foreseeable at this time. I KNOWINGLY AND VOLUNTARILY ASSUME ALL SUCH RISKS, BOTH KNOWN AND UNKNOWN, EVEN IF ARISING FROM THE ACTS OF RELEASEES (defined below), UNLESS THE RISKS ARISE SOLELY FROM THE RELEASEES’ NEGLIGENCE, GROSS NEGLIGENCE, OR INTENTIONAL MISCONDUCT and I assume full responsibility for my child’s participation in the Program.
- I understand and agree
Release and Waiver of Liability*
I, on behalf of myself, my personal representatives, heirs, executors, administrators, agents, and assigns, HEREBY RELEASE, WAIVE, DISCHARGE, AND COVENANT NOT TO SUE APU, including its governing board, trustees, directors, officers, employees, and any Participants, agents, or volunteers acting at APU’s direction (collectively referred to as “Releasees”), for any and all liability, including any and all claims, demands, causes of action (known or unknown), suits, or judgments of any and every kind (including attorneys’ fees), arising from any injury, illness, damage, or death that my child may suffer as a result of my child’s participation in the Program, REGARDLESS OF WHETHER THE INJURY, ILLNESS, DAMAGE, OR DEATH IS CAUSED BY THE RELEASEES, UNLESS THE INJURY, ILLNESS, DAMAGE, OR DEATH IS CAUSED SOLELY BY THE RELEASEES’ NEGLIGENCE OR GROSS NEGLIGENCE OR INTENTIONAL MISCONDUCT, AND REGARDLESS OF WHETHER THE INJURY, ILLNESS, DAMAGE, OR DEATH OCCURS WHILE IN, ON, UPON, OR IN TRANSIT, INCLUDING OVERNIGHT STAY, TO OR FROM THE PREMISES WHERE THE PROGRAM, OR ANY LOCATION ADJUNCT TO THE PROGRAM, OCCURS OR IS BEING CONDUCTED. I further agree that the Releasees are not in any way responsible for any injury, illness, or damage that my child sustains as a result of my child’s own negligent or grossly negligent acts, or my child’s intentional misconduct and I hereby release Releasees from any liability for the same. APU expressly disclaims liability for actions of third parties, which includes but is not limited to other participants in the Programs, agents, or volunteers who are not acting under the direction and control of APU. I, hereby release Releasees from any and all liability, including any and all claims, demands, causes of action (known or unknown), suits, or judgments of any and every kind (including attorneys’ fees), arising from any injury, illness, damage, or death that I may suffer as a result of actions of any third parties who are not Releasees.
- I understand and agree
Indemnity*
I, on behalf of myself, my personal representatives, heirs, executors, administrators, agents, and assigns, agree to hold harmless the Releasees from any and all liability, including any and all claims, demands, causes of action (known or unknown), suits, or judgments of any and every kind (including attorneys’ fees), arising from any injury, illness, damage, or death that my child may suffer as a result of my child’s participation in the Program, REGARDLESS OF WHETHER THE INJURY, ILLNESS, DAMAGE, OR DEATH IS CAUSED BY THE RELEASEES OR OTHERWISE, UNLESS THE INJURY, DAMAGE, OR DEATH IS SOLELY CAUSED BY THE RELEASEES’ NEGLIGENCE, GROSS NEGLIGENCE, OR INTENTIONAL MISCONDUCT. I further agree that, in the event that I or any of my family members, personal representatives, heirs, executors, administrators, agents, assigns or any other third party attempts to assert any claims, demands, causes of action (known or unknown), suits, or judgments of any and every kind (including attorneys’ fees), arising from any injury, illness, damage, or death to me, including, but not limited to, any injury resulting from my own negligence, gross negligence, or intentional misconduct during or related to the Program, I AGREE TO DEFEND AND INDEMNIFY RELEASEES AGAINST SUCH CLAIMS, DEMANDS, CAUSES OF ACTION (KNOWN OR UNKNOWN), SUITS, AND/OR JUDGMENTS OF ANY AND EVERY KIND (INCLUDING ATTORNEYS’ FEES) to the fullest extent permitted by Law.
- I understand and agree
I HAVE READ ALL QUESTIONS INCLUDED IN THIS FORM THOROUGHLY, AGREE TO ITS TERMS AND I CERTIFY THAT THE ABOVE INFORMATION IS TRUE AND ACCURATE AND COMPLETED TO THE BEST OF MY KNOWLEDGE.*
If you agree to the above statement, please type your name in the box below.

Camp Kellogg Registration Summer 2024

Step 1 of 4

Sessions

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