Summer Camp Application

Camp leaders will consist of experienced laborers and mentors from Sejah Farm who will provide hands-on instruction, guidance, and support to participants throughout the program.

Participants are responsible for securing their own rides to and from Sejah Farms. Adult volunteers and chaperones will transport the participants for any field trips/days.

Participants may be offered mentorship intended to help young people personalize the values of stewardship, responsibility, teamwork, and healthy living learned through home, farm, and camp activities. Mentorship may include private conversations with an adult mentor conducted in plain view of others. When working with youth, appropriate confidentiality will be respected to encourage open dialogue; however, any concerns involving abuse, neglect, threats to safety, or risks to physical or emotional well-being will be reported to the appropriate authorities and to parents or guardians, except in cases where a parent or guardian may be the alleged source of harm.

The child named above is in good health and has no physical or medical limitations that would cause the activities as described above to be detrimental or dangerous to the child. Parents/guardians should specify allergies and medical problems in section above.

I hereby attest that I am (we are) the legal parent\guardian(s) of the above-named child and hereby consent to the child's participation in the activities described above. I understand that activities of the kind described above may result in physical injury to my child but nonetheless specifically request that he or she be allowed to participate in those activities.

I/We understand that Sejah Farms VI LLC. does not carry any insurance relative to the activities or for any injury that may occur to the above-named child. I/We represent that the child is (a) covered by insurance through my own insurance carrier; or (b) that I/We am personally financially responsible for any and all medical costs incurred as a result of the child's injury.

If the above-named child requires any emergency medical treatment or procedures during the activities, I hereby consent to and authorize the above-named activity supervisor(s) to make any decision and take any action to arrange for such procedures or treatments in the discretion of the activity supervisor(s).

I release and waive, and further agree to indemnify, hold harmless or reimburse , Sejah Farms VI LLC, the individual members, agents, employees and representatives thereof, as well as activity supervisors, from and against, any claim which I, any other parent or guardian, any sibling, the above-named child, or any other person, firm or corporation may have or claim to have, known or unknown, directly or indirectly, for any losses, damages or injuries arising out of, during, or in connection with the child's participation in the activities (including all forms of transportation) or the rendering of emergency medical procedures or treatment, if any.

If, in the event of a medical or other emergency, I am unable to be reached by telephone at my home or work telephone numbers listed below, I authorize the activity supervisor(s) to attempt to contact me through the emergency contacts listed below.