TODAY'S DATE: April 20, 2024 CAMP BREAKERS ACKNOWLEDGMENT, RELEASE AND INFORMED CONSENT I grant the child(ren) listed below permission to take part in the Camp Breakers program (Children's Program). This consent includes any and all activities undertaken during this program, such as playground activity, children's crafts, sports, swimming, and scavenger hunts.
In and for consideration of my child(ren)'s participation in the Children's Program, I, as a parent/guardian of the below named child(ren), on behalf of my child(ren), hereby agree to the following: Acknowledgment I agree to accept and assume all risks of any and all injuries sustained by my child(ren) resulting from the inherent risks arising out of my child(ren)'s participation in the Children's Program. Inherent risks are those dangers or conditions, known or unknown, which are characteristic of, intrinsic to, or an integral part of the activity and which are not eliminated even if the activity provider acts with due care in a reasonably prudent manner, including, but not limited to exposure to COVID-19, the failure by the activity provider to warn the natural guardian or minor child of an inherent risk; and the risk that the minor child or another participant in the activity may act in a negligent or intentional manner and contribute to the injury or death of the minor child. I further acknowledge that there is a risk of COVID-19 exposure in any public place where people are present. COVID-19 is highly contagious and can lead to illness and death. The Breakers has taken enhanced health and safety measures recommended by the CDC, however, the risk of contracting COVID-19 cannot be completely eliminated, and the services I am requesting necessarily involve use of public space, equipment and interaction with other people. Therefore, I voluntarily assume all risks related to exposure to COVID-19. Release I waive and release, in advance, The Breakers, The Breakers Palm Beach, Inc., Flagler System Inc., and their parent companies, subsidiaries, affiliates, officers, directors, shareholders, employees, agents, successors and assigns (collectively The Breakers Parties) from and against any and all costs, claims, demands, losses, expenses, damages or causes of action (including but not limited to attorneys fees at all judicial levels), that my child(ren) have now or may have in the future (or that my or my child(ren)'s executors, administrators, heirs, next of kin, successors or assigns may have now or may have in the future) for any illness including COVID-19, personal injury, property damage, loss or other liability (including but not limited to liability for medical malpractice arising out of or relating to any treatment or care from employees, nurses, doctors, hospitals or other medical units, for any injuries sustained by my child(ren)), which would accrue to the minor child(ren) resulting from the inherent risks arising out of my child(ren)'s participation in the Children's Program. NOTICE TO THE MINOR CHILD'S NATURAL GUARDIAN READ THIS FORM COMPLETELY AND CAREFULLY. YOU ARE AGREEING TO LET YOUR MINOR CHILD(REN) ENGAGE IN A POTENTIALLY DANGEROUS ACTIVITY. YOU ARE AGREEING THAT, EVEN IF THE BREAKERS PARTIES USE REASONABLE CARE IN PROVIDING THIS ACTIVITY, THERE IS A CHANCE YOUR CHILD(REN) MAY BE SERIOUSLY INJURED OR KILLED BY PARTICIPATING IN THIS ACTIVITY BECAUSE THERE ARE CERTAIN DANGERS INHERENT IN THE ACTIVITY WHICH CANNOT BE AVOIDED OR ELIMINATED. BY SIGNING THIS FORM YOU ARE GIVING UP YOUR CHILD(REN)'S RIGHT AND YOUR RIGHT TO RECOVER FROM THE BREAKERS PARTIES IN A LAWSUIT FOR ANY ILLNESS INCLUDING COVID-19, PERSONAL INJURY, INCLUDING DEATH, TO YOUR CHILD(REN), OR ANY PROPERTY DAMAGE THAT RESULTS FROM THE RISKS THAT ARE A NATURAL PART OF THE ACTIVITY. YOU HAVE THE RIGHT TO REFUSE TO SIGN THIS FORM, AND THE BREAKERS PARTIES HAVE THE RIGHT TO REFUSE TO LET YOUR CHILD(REN) PARTICIPATE IF YOU DO NOT SIGN THIS FORM. I fully understand, acknowledge and agree that The Breakers is relying upon my electronic signature and this document, which is intended to induce The Breakers to allowmy child(ren) to participate in the Children's Program. I further acknowledge that The Breakers has accepted this document as partial consideration for the participation of my child(ren) in the Children's Program. Informed Consent I acknowledge that I have read this Consent and Release carefully and fully understand its meaning, and I am voluntarily executing same as the parent/guardian for each minor guest. This Consent and Release is valid for a period of thirty (30) days unless I notify The Breakers in writing that such consent and release is revoked. I Agree
Acknowledgement of Necessary Health Disclosures and Consent for First Aid I acknowledge that The Breakers has required that prior to permitting participation in the Children's Program, I must disclose any medical condition, allergy or prescription medication my child(ren) may be taking which may be contra-indicated to participation in the program. I acknowledge that it is not The Breakers' responsibility to determine if any medical condition, allergy or prescription medication my child(ren) may be taking is contra-indicated with the program. I acknowledge that all such disclosures, if any, have been made to The Breakers and further represent and warrant to The Breakers that I am not aware of any health restrictions or other limitations that would restrict my child(ren) from participating in the Children's Program. I consent to the treatment of my child(ren) for minor injuries (first aid) by the staff of The Breakers. I Agree
Rules and Policies I understand that my and my child(ren)'s participation in the Children's Program is conditioned on the observance of all the rules and policies promulgated by The Breakers as follows: - The Children's Program is open to all children of hotel guests and club members ages 3-12. Children must be fully potty-trained and not in pull ups.
- For the safety of all participants and staff, children with an infection or a contagious illness may not participate.
- Children must begin the program session promptly at session start time to be guaranteed admittance into the program.
- Please dress children appropriately in active wearand sneakers. Please bring a bathing suit for daytime sessions.
- The Breakers is able to customize meals to meet allergy and dietary restrictions.Outside meals are not permitted.
- Medication is not administered in the Children's Program. The only exception is an epinephrine pen, which must be wornon the child in the carrying case provided by the Children's Program.
- Children are only released to a parent or guardian. If the authorized individual is unknown to Children's Programstaff, identification must be provided.
- The Children's Program has zero tolerance for inappropriate behavior.
- Refunds will not be made for early withdrawals or disciplinary dismissal.
- Reservations must be cancelled by 9:00 PM the preceding day for Day Camp and 3:00 PM the day of for Night Camp. Reservations cancelled outside of this period are subject to cancellation fees.
Stages for Discipline: - Step 1 - A VERBAL WARNING
- Step 2 - A FIVE MINUTE TIME OUT FOR CONTINUED INAPPROPRIATE BEHAVIOR.
- Step 3 - DISMISSAL FROM CAMP.
I fully understand the above policies and agree to comply with them. I Agree
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