ACKNOWLEDGMENT, WAIVER AND RELEASE AGREEMENT, AND INDEMNIFICATION AGREEMENT
The undersigned, parent/guardian of a minor child who intends to attend the Stargazer Day Camp Program at Good Shepherd Catholic Academy located at 1943 Brown St., Brooklyn, NY 11229 (the “School”), and Marine Park located on Fillmore Ave., Brooklyn, NY 11234 (the “Park”), Hereby acknowledges that the Stargazer Day Camp Program is not sponsored by the School or Park, and is being provided solely by Stargazer Day Camp on the School's and/or Park’s premises. This camp is licensed by the New York City Department of Health and Mental Hygiene; is inspected twice yearly; and, the inspection reports can be found at 1142 Remsen Avenue, Brooklyn NY 11236. I hereby acknowledge and accept that there are certain risks arising from or in connection with the Stargazer Day Camp Program, including but not limited to bodily injury. I am fully aware of the risks and hazards connected with the activity, and voluntarily assume full responsibility for any risks of loss, property damage or personal injury that may be sustained by my son or daughter as a result of my taking the Stargazer Day Camp Program, whether caused by the negligence of the School, Stargazer Day Camp Program, or otherwise.
I hereby represent and warrant that my child is in good health and that she has no health condition(s), illness or communicable disease that may make his or her use of the Good Shepherd Catholic Academy and Marine Park facilities injurious to him or her, or any other user of the facilities previously mentioned. If my child should develop any such condition, illness disease during the term of the Stargazer Day Camp Program, I promise to have my child cease attendance at the Stargazer Day Camp Program until we have received an appropriate medical release from him or her doctor authorizing him or her to continue.
I hereby release and forever discharge Stargazer Day Camp, Good Shepherd Catholic Academy, Good Shepherd Catholic Church, Marine Park, and their trustees, owners, officers, servants, agents and employees from any and all liability for any damages, losses or injuries which may be sustained or suffered by my child arising out of, during or in connection with the Stargazer Day Camp Program.
I hereby release and discharge Stargazer Day Camp (the “Camp”), Gordon Harry, Gaelle-Ciara Georges, Khia Williams, Matthew Norris, Khendra Coward, Good Shepherd Catholic Academy, Good Shepherd Catholic Church, Marine Park, and affiliated entities, and their respective officers, servants, agents, or employees (hereinafter referred to as the “Releasees”) from any and all liability whatsoever arising out of or in connection with my child’s participation in the Camp and Program. I hereby agree to indemnify and hold harmless the Releasees from any loss, liability, damage, or costs, including court costs and attorneys’ fees that may be caused by my child’s participation, including traveling to/from the Program or participating in the Program in, on, upon, or near the schools where the Program is being conducted, whether caused by negligence of the Releasees or otherwise.
I hereby hold harmless Stargazer Day Camp, Good Shepherd Catholic Academy, Good Shepherd Catholic Church, Marine Park, and their trustees, owners, officers, servants, agents and employees from any and all liability, loss or damage they or any of them incur or sustain as a result of any claims, demands, judgments, costs, or expenses, including attorney’s fees, which may result from, arise out of, or relate to the Stargazer Day Camp Program.
I further represent and warrant that my child’s participation in Stargazer Day Camp is covered by a policy of comprehensive health and accident insurance that provides coverage for injuries that my son or daughter may sustain as part of his or her participation in the Stargazer Day Camp Program.
I certify that I:
(A) am the parent or legal guardian of the above participant,
(B) have read the forgoing Acknowledgment, Waiver and Release Agreement
(including such parts as may subject me to personal financial responsibility)
(C) am and will be legally responsible for the obligations and acts of the participant as described in this Acknowledgment, Waiver and Release Agreement, and
(D) agree, for myself and for the participant, to be bound by its terms.
RELEASE AND CONSENT FORM
I hereby release and discharge Stargazer Day Camp (the “Camp”), Gordon Harry, Gaelle-Ciara Georges, Khia Williams, Matthew Norris, Khendra Coward, Good Shepherd Catholic Academy, Good Shepherd Catholic Church, Marine Park, and affiliated entities, and their respective officers, servants, agents, or employees (hereinafter referred to as the “Releasees”) from any and all liability whatsoever arising out of or in connection with my child’s participation in the Camp and Program. I hereby agree to indemnify and hold harmless the Releasees from any loss, liability, damage, or costs, including court costs and attorneys’ fees that may be caused by my child’s participation, including traveling to/from the Program or participating in the Program in, on, upon, or near the school where the Program is being conducted, whether caused by negligence of the Releasees or otherwise.
CONSENT FOR EMERGENCY MEDICAL TREATMENT
I do hereby give authority to Stargazer Day Camp Program staff to obtain necessary emergency medical treatment for my child with the understanding that the family will be notified as soon as possible.
PARENT OR GUARDIAN MUST SIGN:
As a parent or legal guardian of below participant, I authorize Stargazer Day Camp to request medical treatment as necessary to insure the well being of the participant. We, the undersigned, for ourselves, or heirs, executors and administrators, waiver and release forever discharge Stargazer Day Camp, Good Shepherd Catholic Academy, Good Shepherd Catholic Church, their ownesr, staff, officers, agents, representatives, employees, successors, and assigns of and from any and all rights claim for damages to person or property which may be sustained or occur during participation in activities, to or from the camp and program whether paid damages, injury or loss are due to negligence or not.
CONSENT FOR EMERGENCY MEDICAL TREATMENT
I do hereby give authority to Stargazer Day Camp Program staff to obtain necessary emergency medical treatment for my child with the understanding that the family will be notified as soon as possible.
ADDITIONAL MEDICAL INFORMATION
Prior to Camp we will need a Medical Form for each participant. Stargazer’s Medical Form requires a Doctor’s statement from a recent physical examination. This form can be given to you via e-mail or in person, and will also be mailed to each participant prior to Camp. You may substitute your own-signed Doctor’s statement, but We require that the Parent/Guardian statement on Stargazer’s form is filled out and turned in with Stargazer Camper Application. A Certified Medical Nurse is on call each day and can administer daily medication if necessary, but only with the special consent of the parent or guardian. You can make these arrangements on the first day of camp.
ADDITIONAL TERMS AND CONDITIONS OF ENROLLMENT
Stargazer Day Camp has the right to suspend or terminate the enrollment of any camper at any time, or to nullify an enrollment contract prior to the beginning of camp at its sole discretion without any refund. Such suspension or termination may result when: (a) a camper disregards or does not abide by the rules and regulations of Stargazer Day Camp; (b) Stargazer Day Camp determines that a camper's conduct or performance demonstrates an unwillingness or inability to be productive within the Stargazer Day Camp community, (c) a parent, guardian, or other individual closely associated with the camper fails to cooperate with Stargazer Day Camp or disregards or does not abide by the rules and regulations of Stargazer Day Camp; (d) Stargazer Day Camp determines that the continued attendance of a camper at Stargazer Day Camp is not in the best interests of the camper or Stargazer Day Camp; (e) Stargazer Day Camp determines that the continued involvement of a parent or guardian with the camp is not in the best interest of the camper or Stargazer Day Camp; (f) other reasons as determined in the sole discretion of Stargazer Day Camp.
I agree to cooperate fully with Stargazer Day Camp and I understand that my child must follow all Stargazer Day Camp rules and regulations.
I agree that my child has permission: (i) to take part in any and all Stargazer Day Camp activities on or off School property, including athletics; (ii) to take Stargazer Day Camp-sponsored field trips; (iii) Big Trips not included in camp fees, and paid for by parents; and, (iv) to ride in vehicles owned or chartered by Stargazer Day Camp and driven by appropriately licensed/trained employees or representatives of Stargazer Day Camp or the company chartered by Stargazer Day Camp.
Parents fully understand, regarding Big Trip Days, that there will be no regular camp on that specified date. Under no circumstance does the camp fee change. Once a camper attends camp, if even only for one day, the parent/guardian is still responsible for the full camp fee payment.
I agree that ALL SALES ARE FINAL, AND PAYMENTS ARE NON-REFUNDABLE. All payments will be non-transferable and considered forfeited for the 2025 camp session(s). There are no refunds issued for MISSED DAYS due to camper illness, ABSENCE, WITHDRAWAL, or TERMINATION from camp; OR Big Trip days.
Notwithstanding the above authorization, I agree to complete and promptly return to Stargazer Day Camp any additional permission slips, releases and/or medical information forms regarding my enrolled camper. Further, I understand that the Camper Medical Information and Authorization is due with Stargazer Camper Application, regardless of the camper's start date.
I agree that Stargazer Day Camp may use the camper's name, portrait, likeness, artwork, written work, or electronic media that he or she develops in connection with Stargazer Day Camp activities or in publicizing Stargazer Day Camp, and that, except as prohibited by law, the Stargazer Day Camp may use my camper's information and records at its sole discretion.
