Summer Camp Application

Page 2

Waivers and Covid-19 Information

By selecting "I Accept" using any device, means or action, you consent to the legally binding terms and conditions of these Agreements. You further agree that your electronic signature on this document is as valid as if you signed the document in writing.

Media Release

I consent to and allow Mountain Resource Center to use and reproduce any and all photographs or videotapes taken of me during my participation in Family Education Programs. I understand that Mountain Resource Center will own the photographs and video and the right to use or reproduce such photographs and videos in any media, and the right to edit them or prepare derivative works for purposes of promotion, advertising and public relations. I hereby consent to Mountain Resource Center’s use of my name, likeness or voice, and I agree that such use will not result in any liability to these parties for payment to any person or organization including myself.

I ACCEPT

Liability Waiver

I understand the risks, hazards, and dangers inherent in carrying out normal day-to-day activities while participating in Family Education Programs. I agree for myself and my heirs, to release and hold harmless, defend and indemnify the Mountain Resource Center, its trustees, officers, agents, employees, and volunteers, from and against all claims, demands, actions, and causes of action as a result of personal injury, death, or property damage sustained by me or by others due to this activity.

I ACCEPT

Covid-19 Waiver and Guidelines

I understand and assume the risk that, despite MRC’s best efforts to prevent spread of the illness, participants may become ill from COVID-19 and such illness may result in serious illness, up to and including death. Participants hereby assume the risk of bodily injury, illness, death, medical treatment, and property damage resulting from attending activities at Mountain Resource Center.

Participants will follow general CDC and the State of CO health guidelines by:

-Not attending class if the participant is currently experiencing symptoms of COVID-19 including but limited to coughing, congestion, loss of taste and smell, or fever.

- Not attending class if the participant has tested positive for COVID-19. If positive for COVID-19, the participant cannot come to class until 5 days have passed and

the participant is symptom free. The participant may return to class after the 5-day mark if symptom free, but the participant will need to wear a mask during the class until day 10.

These requirements may change at any time to comply with local and national guidelines.

I ACCEPT

Electronic Signature

American Indian or Alaska Native	Asian
Black or African American	Hawaiian Native or Pacific Islander
Multiracial	White
Other	Prefer Not To Say

Phone	Email
Do Not Contact	No Preference

Living in car	Living in RV/Tent
Living with Friends/Family	Living in a Shelter
Living in a Rented Home	Living in a Owned Home

None	SNAP	Medicaid	TANF
SSI	SSDI	Other

American Indian or Alaska Native	Asian
Black or African American	Hawaiian Native or Pacific Islander
Multiracial	White
Other	Prefer Not To Say

Spouse	Partner
Child	Grandparent
Grandchild	Family
Friend	Other
Self	Guardian
Ward	Foster Parent
Foster Child

	Yes	No	Not Applicable
Does your household have difficulty accessing enough food without assistance?
Is your housing unstable? Do you have trouble paying rent?
Are any adults in your household unemployed/ underemployed?
Are there members of your household that do not have access to a medical provider?
Are there members of your household without health insurance?
Do you want parenting support and resources?
Would you like to receive the newsletter?

Male	Female
Non-Binary	Prefer Not To Say