I approve this registration and certify that my child is in good health and capable of such an experience. I understand the acceptance of this application for overnight campers is contingent upon the camper passing a physical exam by a family physician within 24 months before attending camp. I grant permission for the camper to participate in all planned camp activities such as, but not limited to: horseback riding, river canoeing, swimming, high ropes, archery, climbing, out-of-camp trips by van or bus, and hiking. In case of an accident or illness, the 4-H Center is authorized to secure emergency medical treatment. I understand prudent attempts will be made to contact the undersigned immediately. I understand that I will be responsible for payment of all medical bills. I understand that in order to provide a safe and cooperative group experience, my child may be dismissed from the program for reasons including behavior, illness/injury, or extreme homesickness. I will assume responsibility for transportation to and from the Iowa 4-H Center (except for day camp daily transportation provided by the camp).

I understand the deposit is not refundable and not transferable under any circumstances. I understand the deposit of $75 per child, per session (or $50 for a half-week session) will be credited toward the camp fee. I agree to pay my camp balance in full by two weeks before my child’s camp session begins or my reservation may be cancelled and my deposit forfeited. I understand that a $25 fee will be charged for each session change I make after May 16, 2012.

I understand that in the event of cancellation: No refunds will be issued unless cancellations are made in writing at least 2 weeks prior to the beginning of my child’s camp session. Program fees will not be refunded after that date unless accompanied by a doctor’s authorized medical reason. I understand that no refunds are given if my child leaves early due to homesickness or disruptive behavior as determined by the Camp Director. Refunds are disbursed in the same form as payment was made.

I understand the Iowa 4-H Center is not responsible for lost, stolen, or damaged personal articles. I authorize the Iowa 4-H Center and Iowa State University Extension to use any photographs, video, or written statements from my child’s experience in public relations and marketing materials including Internet without compensation.

I understand that although the Iowa 4-H Center has taken reasonable steps to provide my child with appropriate training, equipment, and skilled staff for his/her camp experience, I acknowledge that some inherent risks cannot be eliminated without destroying the unique character of these activities. Campers have the responsibility, as a voluntary participant, to abide by all rules, to listen, and to follow all instructions given by activity leaders. In the event of an unforeseen or reasonably unpredictable circumstance, by our camper’s voluntary participation in an activity, I am aware of and have acknowledged the existence of a risk and I clearly share in its assumption.

I individually and corporately agree to hold harmless Iowa State University, ISU Extension, the Iowa 4-H Foundation, the Iowa 4-H Center, its volunteers, agents, employees, and officers irrespective of any negligent act or omission by the 4-H Center and/or those individuals arising from or related in any way to Iowa State University and the 4-H camping program.