PLEASE DO NOT BRING THESE ITEMS TO CAMP: (these items are prohibited)

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1 Please print and fill out the attached medical history/check-out permission form and release agreement form. Your release agreement and medical history/check-out permission form must be completed and returned to the Camp Administrator BEFORE your child will be allowed to participate in camp. If your camper will need to take medication during camp hours, please also print and fill out the Authorization to Administer Medication form, and be sure to provide the medication at camp check-in. Your camper will need the following supplies while at camp: sunscreen (VERY VERY IMPORTANT!!) a lock to lock your stuff up in the bathroom lockers (VERY IMPORTANT!) swimsuit towel change of clothes and footwear sweatshirt or windbreaker for chilly mornings footwear (sandals, flip flops, etc) lunch except on Fridays because we provide a picnic lunch for parents and campers! back pack large enough to hold the above items (make sure to have identifying marks on all of your belongings) Any medications you may need. (Please note any medications you camper will be carrying on the medical history form. If medication needs to be administered, please fill out the Authorization to administer medication form and attach it to the medical history.) Optional items to bring to camp: hat and/or sunglasses water bottle lunch money for sail/kayak to lunch day (campers will be notified on Monday which day to bring this and then reminded one day prior) Vending machine money- There is a snack and drink machine at camp. Price range from $1-$2. PLEASE DO NOT BRING THESE ITEMS TO CAMP: (these items are prohibited) Unnecessary electronics such as ipods, video games, etc Expensive or fragile items Jewelry Sharp items such as scissors or pocket knives Important Reminders: Be sure to keep all personal and valuable items to a minimum while attending camp. iphones and other expensive smart phones and electronics are especially susceptible to theft and loss and should be properly stowed while at camp. Campers should not have these items out or be using them at camp unless absolutely necessary. We are not responsible for any lost, stolen or broken items.

2 Please remember sunscreen for your child! Sunburns are dangerous and not fun. Please remind campers to reapply several times a day. Our staff works hard to remind campers and always have some available, please help reinforce the importance of this issue. Label all personal equipment and belongings with your child s name to ensure easy identification and return if misplaced. If some does get lost, check the lost and found in the camp patio. If your child needs to be picked up or dropped off during the schedule of a normal day, please contact the Camp Administrator or the Camp Director prior to that day. Special pickup or drop off MUST be pre-approved or take place between 11:00am and 11:45am or campers may be on the water and not accessible. Help prevent the spread of illness. If your child has a fever of over 100 degrees and either a sore throat or cough within 7 days of camp, please do not bring them to camp. We will arrange to reschedule your session. If you have any questions, please do not hesitate to contact us at (858) Thank you and we look forward to seeing you at camp soon! Thank you, The Watersports Camp

3 MEDICAL HISTORY/CHECK-OUT PERMISSION FORM CHILD S NAME BIRTHDATE AGE FATHER S NAME_DAY PHONE( ) EVENING PHONE( ) CELL PHONE( ) ADDRESS CITY STATE ZIP MOTHER S NAME_DAY PHONE( ) EVENING PHONE( ) CELL PHONE( ) ADDRESS CITY STATE ZIP IN CASE OF EMERGENCY-NOTIFY *Please list two emergency contacts other than parents NAME DAY PHONE EVENING PHONE FAMILY PHYSICIAN PHONE( ) Please list any conditions that currently require regular medication (If you will be requiring us to administer medication you must sign the Authorization to Administer Medication form at camp check-in): Does your child have any physical or developmental limitations with regard to these activities that might require special attention for your child s safety during participation? May we contact any previous providers? (please use the back of this page if necessary) * CAMP CHECK-OUT * In order to ensure the safety of all campers, we will be checking the identification of any parent/sibling/friend/carpool driver that will be picking up campers. Please list all individuals approved to pick up your child(ren) from camp. ONLY INDIVIDUALS LISTED ON THIS FORM WILL BE ALLOWED TO PICK UP A CHILD. Photo identification is REQUIRED (ex. Valid driver s license). Completed forms can be mailed to 1001 Santa Clara Place, San Diego, CA up to two weeks prior to the start of camp. If within two weeks of camp please fax the forms to (858) or bring them with you to the first day of camp.

4 PENINSULA FAMILY YMCA YOUTH PROGRAMS RELEASE AGREEMENT In consideration of the use of the property, facilities and/or services of the Peninsula Family YMCA Youth Programs, including any travel related thereto, the undersigned agrees as follows: 1. RISK FACTORS. The undersigned understands and acknowledges that the activities of wakeboarding, waterskiing, surfing, sailing, windsurfing, kayaking, rowing, marine science, related water sports, beach activities, transportation during camp, and transportation before and after camp by camp personnel involve risks such as but not limited to the following which might result from the activity itself, the acts of others or the unavailability of emergency care; RISK OF PROPERTY DAMAGE, BODILY INJURY, and POSSIBLY DEATH. 2. ASSUMPTION OF RISK. The undersigned ASSUMES ALL RISKS WHICH ARE FORESEEABLE AND INVOLVED WITH OR ARISING FROM THE ACTIVITY, including without limitation those risks described in Section 1 above. 3. SKILLS AND TRAINING. The undersigned acknowledges that the below named minor has the skills, qualifications, physical ability and training necessary to complete such activity. The undersigned agrees that if he or she has any questions as to what skills, qualifications or training is necessary to properly participate in the activity, then they shall direct such questions to the Mission Bay Youth Water Sports Camp management. 4. RELEASE. The undersigned RELEASES the State of California, Peninsula Family YMCA, the YMCA of San Diego County, the Trustees of the California State Universities, San Diego State University, Regents of the University of California, the University of California San Diego, the Associated Students of San Diego State University and all of their officers, employees and agents (referred to below as the RELEASED PARTIES ) and agrees NOT TO SUE them on account of or in connection with any claims, causes of action, injuries, damages, cost or expenses (referred to below as CLAIMS ) arising out of the activity, including those based on the risks described in Section 1, whether or not caused by the negligence or other fault of the RELEASED PARTIES. 5. WAIVER. The undersigned waives the protection provided by any statute or law in any jurisdiction including California Code section 1542 whose purpose, substances and/or effect is to provide them a general release shall not extend to claims, material or otherwise which the persons giving the release does not know or suspect to exist at the time of executing the release. This means, in part, that the undersigned is releasing unknown future claims. 6. INDEMNIFY AND DEFEND. The undersigned agrees to INDEMNIFY AND DEFEND the RELEASED PARTIES against, and hold them harmless from, any and all CLAIMS, including attorney fees, which in any way arise from the activity which is the subject of this agreement and which include but are not limited to those risks described in Section 1 including any liability arising from the act or negligent act of the RELEASED PARTIES, the below named minor or anyone else. 7. PAY. The undersigned agrees to pay for any and all damages to any property of the RELEASED PARTIES caused by the undersigned whether negligently, willfully or otherwise. 8. LEGAL FEES. In the event of any controversy, claim or dispute between the parties arising out of or relating to this agreement or the breach hereof or the activity, the prevailing party shall be entitled to recover from the losing party reasonable expenses, attorney fees and costs. 9. REPRESENTATIVES. The undersigned enters into this agreement for himself/herself, heirs, assigns and legal representatives. 10. ACKNOWLEDGEMENT. The undersigned has read and understands this agreement and realizes it relates to releasing valuable legal rights and does so freely and voluntarily. 11. TOWER ACKNOWLEDGEMENT. For use of Air Nautique wakeboard boats with a tower, I further understand this exposes the above named minor to the additional risks of a large wake and the possible serious injuries resulting from aerial or other maneuvers. NAME OF MINOR AGE APPROVAL OF PARENT/LEGAL GUARDIAN ON BEHALF OF MINOR I am the parent and/or legal guardian of the above-named minor. I have read and understand the agreement and realize the agreement involves releasing valuable legal rights of the minor and myself. I agree to be bound by all of the terms of the agreement. I also give my consent to the participation in the activity by the minor. I also give my consent for my child to be included in photographs, videos, slides, and movies taken at the Center by students, staff, TV, Radio and/or other news media. I understand that pictures become property of Associated Students of SDSU, and might appear in promotional materials, publications, and social media. SIGNATURE OF PARENT AND/OR LEGAL GUARDIAN DATE IF PERSON PARTICIPATING IS UNDER 18 PARENT OR LEGAL GUARDIAN EMERGENCY TREATMENT CONSENT As the parent and/or legal guardian, I agree to the participation by the minor in the subject activity. The undersigned hereby gives consent to medical treatment of the minor in case of an emergency. SIGNATURE OF PARENT AND/OR LEGAL GUARDIAN IF PERSON PARTICIPATING IS UNDER 18 THIS FROM MUST BE RETURNED TO THE MISSION BAY YOUTH PROGRAMS OFFICE BEFORE YOUR CHILD CAN PARTICIPATE IN THE YOUTH ACTIVITIES. IF THIS FROM IS NOT ON FILE IN THE YOUTH PROGRAM OFFICE, YOUR CHILD WILL NOT BE ALLOWED TO PARTICIPATE UNTIL THE PARENT OR LEGAL GUARDIAN SIGNS FOR THEM. THIS FORM MAY NOT BE EDITED OR CHANGED IN ANY WAY. IF YOU HAVE ANY QUESTIONS REGARDING THIS RELEASE FORM, PLEASE CONTACT THE YOUTH PROGRAM DIRECTOR AT (858)

5 CAMP POLICY FOR MEDICATION For the safety of our students, we have a strict policy for the handling of medication at camp. Our medication policy changes and evolves each season. If your child will be taking medication while at camp, please be sure to follow the specific procedures listed below. Please note: Students will not be admitted to camp if these procedures are not followed. We ask that students attending camp please take ALL medication and/or vitamins before camp, unless they MUST be taken during camp hours. ALL medication MUST be brought to camp in their ORIGINAL CONTAINERS on your child s first day of camp. Please do not take the medication out of the container. The original container must identify (in English) the prescribing physician (if a prescription drug), the name of the medication, the dosage and the frequency of administration. Students will be responsible for self administering medication in accordance with the instructions below. In the case of emergency, or the camper cannot administer the medication themselves, a camp staff member will assist. Students needing injections (insulin, hormones, etc.) will need to self-administer the medication. Camp staff are not trained in this area. All medication information MUST be completely entered in your child s Health History form. It is the responsibility of the Parent/Guardian to pick up any remaining medication at the end of the week. Any medication and/or vitamins left at camp will be disposed of. AUTHORIZATION TO ADMINISTER MEDICATION I HEREBY AUTHORIZE the designated representatives of The Watersports Camp to administer the medication described below. It is the policy of MBAC to provide the medicine to the camper to self administer in accordance with instructions below. Should the camper be unable to administer the medication themselves, a staff member will assist in the administration. In consideration of the administration of this medication in accordance with the direction s of my child s doctor, I hereby release The Watersports Camp and its agents or representatives or employees from any and all liability for damages resulting from the administration of this medication to my child. I further agree to hold harmless and indemnify MBYWSC and its agents or representatives or employees from any costs or expenses associated with any claim brought against them for actions taken pursuant to this Authorization to Administer Medication and such indemnification to include attorney fees, costs of any litigation or claim or any damages or out of pocket costs occasioned by The Watersports Camp, its agents or representatives or employees. Child s Name Date Parent/Legal Guardian* Date Prescribing Physician Physician Phone Medication #1: Dosage: Time taken: Reason for taking: Medication #2: Dosage: Time taken: Reason for taking:

6 CAMP DEMOGRAPHIC INFORMATION Please help us to make Camp better in the future by taking a few minutes to answer the following questions. Please feel free mail this questionairre following your week of camp, or drop it off at the front desk on Friday of your camp week. 1. Is this your first year registering for our Camp? YES NO If NO, what year(s) did you attend? 2. How did you hear about our Camp? Newspaper or Magazine (which one) Friends School Flyer Camp Fairs or Expos (which one) Other 3. What school does your child(ren) attend? 4. Do you have any suggestions that you think would make our Camp easier to use or more enjoyable for you and your family or friends? 5. Is there any sports or programs or services you would like to see offered in the future? 6. Would you be interested in a winter or spring camp program? If so, which activities? 7. Do you have a friend who would be interested in our Camp? If YES, please provide his/her address so that we can send him/her a Camp brochure? Name: Address: City: State: Zip: Phone: Thanks for your help.