Program Permission Form 

1. Athletic Activities and Swimming: I hereby permit my child to participate in athletic activities and swimming. 

2. Injury: I agree to release, not sue, and hold harmless both JCY Day Camp, their staff, and/or Jewish Federation of Northwest Indiana staff (both parties herein referred to as “Organization Staff”) from any damage, injury, or expense resulting from the voluntary attendance/participation in JCY Day Camp’s Bounce House of the camper(s) for whom I registered.

3. Media: I give my permission for my child’s camp photos and/or camp videos to be used for camp publicity purposes, web sites, or for sale to camp families.

4. Medical Attention: I give permission for my child to receive appropriate medical attention from Organization Staff such as first aid, CPR, Heimlich maneuver, etc., or if it is determined that my child needs immediate professional medical care, I authorize to transport him or her, or have him or her transferred to the nearest medical facility. To the extent possible under the circumstances, parents/guardians and/or other identified emergency contacts will be contacted immediately. I understand that I will be responsible for all of his/her expenses related to emergency medical services.

5. Medication Administration: I hereby authorize Organization Staff to facilitate the use of medications by my child as stated on the Emergency/Health Information Form. I agree to release and hold harmless the camp and its personnel from lawsuit, claims, expense, demand, or action against them for assisting my child with medication use, provided the staff complies with the authorized orders I have established in the aforementioned note. I understand that the camp does not employ a physician or nurse to assist in the distribution or use of medication, and that the camp and its staff, in following my written orders, are relying upon my representation, that the use of the identified medications by my child is reasonable and appropriate. In the event that my child requires unplanned over-the-counter medication, I authorize Organization Staff to administer said medication provided that they obtain my verbal permission via a phone call.

6. Sunscreen/Insect Repellent: I agree to release and hold harmless the camp and/or its personnel from lawsuits, claims, expense, demand or action against them for applying sunscreen and/or insect repellent, provided that the camp and/or its staff comply with the instructions provided.

7. Transportation: I understand that I am legally responsible for my child while he or she is en route to and from JCY Camp programs.

8. Trips: I hereby permit my child to accompany an authorized Organization Staff on excursions to places of interest (i.e. field trips). I release Organization Staff of all responsibilities other than reasonable care.  I understand that the camp, in its discretion, may elect to contract with an outside agency, such as a bus company or other common carrier, for the provision of transportation services for such events. I further understand that such an outside agency will be an independent contractor and, so long as the camp has exercised reasonable care in the selection of that contractor, I release and agree to hold the camp harmless for any negligence or fault on the part of the contractor.

9. COVID-19 and other Communicable Disease: 

• I understand that my child must comply with any and all Health and Safety protocols set forth by JCY Day Camp. I understand that refusal to comply with any rules and regulations could result in my child’s removal from JCY Day Camp.

• I understand that my child will not be permitted to attend JCY Day Camp if they are exhibiting one or more symptoms of COVID-19 or any other communicable illness/disease, and that I should keep my child home in this instance. 

I give my permission for all the foregoing.