Please fill out all required and relevant information. Your Summer Day Camp registration will not be considered complete until we receive this form.
It is especially important for us to know about bee sting and food allergies (check YES and list below).
ATTENTION! We cook and/or serve snacks every day so this is important.
Any medication your child brings to camp should be in a ziplock bag clearly labeled with his or her name.
We strive to create an inclusive environment for participants of all abilities and backgrounds. It is important for our planning that we be aware of the needs of our campers.
In the event of an emergency, if we cannot reach you, indicate your permission to authorize emergency care by checking YES.
Any person, other than the authorizing parent, who is picking your child up must be listed on this form and must show identification at pick-up. If you want your child to be able to sign themselves in and out, please list their name on the form as well. Child will not be allowed to leave with any person without written authorization from parent or authorized representative.
Indicate your permission to authorize the following people to pick-up your child by checking YES.
Names of Persons Authorized to Take Child from Facility
If you must cancel your registration you will be eligible for a full refund (minus a $25 processing fee) if the cancellation is made at least 3 weeks before the camp starting date. Cancellations received with less than 1 weeks’ notice will not be eligible for any refund unless a replacement is available to take your camper’s spot.
Please indicate that you have read and agree to abide by the cancellation policy by checking YES.
Soil Born Farms (“SBF”) is a nonprofit organization whose mission is to empower youth and adults to discover and participate in a local food system that encourages healthy living, nurtures the environment and grows a sustainable community. By signing below, I, the parent or legal guardian agree that:
1. Policies and Safety Rules. For my safety and that of others, I will comply with SBF’s policies, safety rules and its other directions for all Summer Day Camp activities that are communicated on arrival to the farm, on signage throughout the farm, and from the SBF Summer Day Camp (“SDC”) Staff. I will supervise any child or other person for whom I am responsible before and after camp. If I become aware of any hazardous condition or danger at an SBF program site, I will alert SBF.
2. Awareness and Assumption of Risk. I understand that my child’s activities with SBF have inherent risks that may arise from SBF’s operations, my/child’s own actions or inactions, or the actions or inactions of SBF, its directors, officers, employees and agents, other volunteers, and others present at SBF farm. These risks may include, but are not limited to: dangers and conditions inherent to farm property and other program sites, including bees, snakes, animals, poison oak, uneven terrain, allergens, and use of tools, and farm equipment; weather; physical exertion; and travel to and from SBF program sites. I assume full responsibility for any and all risks of bodily injury, death or property damage caused by or arising directly or indirectly from my/my child’s presence at SBF or participation in SBF activities, regardless of the cause.
3. Waiver and Release of Claims. I waive and release any and all claims against: SBF; the owner or owners of premises on which SBF programs take place including owners of sites for gleaning activities (collectively, “landowners”); other tenants at SBF’s or landowners’ premises; the County of Sacramento (the “County”); and SBF’s, landowners’, the County’s, and other tenants’ directors, officers, agents, employees, volunteers, and affiliates (collectively, the “Released Parties”), for any liability, loss, damages, claims, expenses and attorneys’ fees (collectively, “Liabilities”) resulting from death, or injury to my person or property, caused by or arising directly or indirectly from my presence at a SBF program site or participation in SBF activities, regardless of the cause and even if caused by negligence, whether passive or active. I agree not to sue any of the Released Parties on the basis of these waived and released claims. I waive the protections of Section 1542 of the California Civil Code, which provides that a general release does not extend to certain claims not known to me at the time I signed this waiver and release. I understand that SBF would not permit my child to participate in Summer Day Camp without my agreeing to these waivers and releases.
4. Medical Care Consent and Waiver. I authorize SBF to provide to me and my child first aid and, through medical personnel of its choice, medical assistance, transportation, and emergency medical services. This consent does not impose a duty upon SBF to provide such assistance, transportation, or services. In addition, I waive and release any claims against the Released Parties arising out of any first aid, treatment or medical service, including the lack or timing of such, made in connection with my/my child’s activities with SBF.
5. Indemnification. I will defend, indemnify, and hold the Released Parties harmless from and against any and all Liabilities, including without limitation, Liabilities arising from any injury, property damage, or death that may be suffered by me, my child, or any person in a relationship with me or any other third party, which may arise directly or indirectly from my SBF activities, except and only to the extent the liability is caused by the gross negligence or willful misconduct of the relevant Released Party.
6. Confidentiality. As a parent or legal guardian of a SDC participant, I may have access to SBF confidential information. At all times during and after my participation, I agree to hold in confidence and not disclose or use any such confidential information except as required in my SBF volunteer activities or as expressly authorized in writing by SBF’s Executive Director.
7. Publicity. I consent to the unrestricted use in any form of any photographs, interviews, film, videotapes, other visual or auditory recordings, in any other medium, including the Internet, of me and my child that the Released Parties or others may create in connection with my/my child’s participation in SBF Summer Day Camp activities. I waive any right to inspect or approve the finished product and acknowledge that I am not entitled to any compensation for creation or use of the finished product.
Please indicate that you have read and agree to abide by the Waiver and Liability Agreement by checking YES.
connecting food, health & the environment