EARLY ENROLLMENT FEBRUARY 1

image2

2019 East Coast Hui Camp Sign Up Form

*Please Printout, Complete & Return Separate Form for Each Additional Surfer*

Surfer First & Last Name:______________________________________________________

Address:______________________________________________________________________

Age:__________________________________________________________________________

Surf Experience Please circle:   First Time   Beginner   Intermediate   Expert

Youth T Shirt Size (S, M, L, XL):_________________________________________________

Adult T Shirt Size (S, M, L, XL, XXL):_____________________________________________

Extra T Shirt Size (not included in camp cost-additional $30.00):________________

Sweatshirt Size (not included in camp cost-additional $50.00):_________________


*******One T Shirt per camper is included with enrollment.  If you wish to purchase additional T shirts they are available for $30.00 each.  Sweatshirts are available for $50.00 each.  Please indicate if you would like a sweatshirt, as they need to be ordered with the T shirts.  Your enrollment paperwork and apparel order must be received by May 1, 2019.  Due to custom design and ordering there will be no overstock or surplus apparel for sale.  Please feel free to contact Bobby for details. 617.548.7988.  Thank you.******

Contacts:

Contact 1/Parent/Guardian please print clearly


First & Last Name:_____________________________

Home Phone Number:________________________

Cell Phone Number:___________________________

Email Address:________________________________


Contact 2/Parent/Guardian please print clearly


First & Last Name:_____________________________

Home Phone Number:________________________

Cell Phone Number: __________________________



SESSION WEEK/WEEKS PLEASE CIRCLE AND INDICATE FIRST CHOICE, SECOND, THIRD, ECT.

June 10-14

June 17-21  SOLD OUT

June 24-28

July 8-12

July 15-19

July 22-26

July 29-Aug 2

Aug 5-9

Aug 12-16 SOLD OUT

Aug 19-23

Aug 26-30

**No Camp Week Of July 4th**

Photography Release:

I give permission to East Coast Hui and its employees to use, reproduce and distribute photographs and videos taken of my child during camp in all forms and media for promotional materials, advertising and trade without further compensation. 

___________Initial Approval __________Initial Disapproval


Daily trips to the convenience store/ice cream truck will be made with staff instructors.

___________Initial Approval __________Initial Disapproval


Please note, public restrooms and showers are the Cook Comfort Station.  All campers either individually, or in groups, will be accompanied for their safety.

___________Initial Approval __________Initial Disapproval


Parent/Legal Guardian Signature:

Inclement Weather Policy:Refund Policy:

In the event that torrential rain/thunder& lightening creates an unsafe environment for campers, parents will be notified that morning of camp cancellation.  Make up days will be permitted any day during the following sessions of camp, which are not to capacity.  Please give us at least 24 hour notice as to which day your camper will be making up the missed day to determine option by calling Bobby at 617.548.7988.  Make up days will not be permitted for missed days due to campers personal scheduling conflicts, but are for poor weather condition cancellations.  Refund Policy: Our commitment to the community and our family owned business refunds will only be applied 30 days prior to scheduled camp week/weeks without exception.  Thank you for your understanding for we have a designated amount of camp registrations available to fun in the surf!!!! 

2019 east coast hui camp health form

image3

To be filled out by parent/legal guardian:

Childs name:_____________________________________________________________

Primary Care Provider:___________________________________________________

Emergency Contact:_____________________________________________________

Emergency Contact relationship to camper:______________________________

Will your child be bringing medication to camp? Y/N

If so, do you authorize camp counselors to administer this medication:

Y/N

Do you authorize emergency medical care to be administered to your child?

Y/N

do you certify that your child has received all required state and federal immunizations, including but not limited to MMR Vaccine, Polio Vaccine, Diptheria, Tetanus Toxoids and Pertussis Vaccines and Hepatitus B Vaccines? Y/N

Do you certify that your child has no known health history or impairments that would prevent him/her from participating in East Coast Hui Surf Camp, or make camp increasingly dangerous for your child? Y/N

Does your child have any allergies or conditions that camp counselors should be aware of?  If so, please explain:______________________________________________________________________

__________________________________________________________________________________________

Do you understand that your child should arrive at camp with a healthy brown bag lunch each day, except for Friday when a pizza party will be held for campers? Y/N

Please list anybody who will be allowed to pick up your child from camp.  Any persons not listed will NOT be allowed to pick up your child.___________________________________________

__________________________________________________________________________________________


***Please note East Coast Hui Surf Camp is required to receive all Health Immunization and Physical Forms prior to your child's spot being confirmed per Hull Board of Health.  Thank you.***


Parent/Legal Guardian's Printed Name:____________________________________________________

Parent/Legal Guardian's Signature:________________________________________________________

Date:____________________________________________


***MEDICATION***THIS IS A MUST***

***Please make sure that your surfer brings any required medication (ie, Epi-Pens, inhalers, ect.) to camp each day.  These items can be given to Bobby each morning to be secured in the EC HUI Medical Lock Box and returned at the end of each day.***

east coast hui surf camp

Additional Information

In consideration of the services of East Coast Hui, their agents, owners, officers, volunteers, participants, employees, and other persons or entities acting in any capacity on their behalf; herein and after collectively referred to as East Coast Hui; I hereby agree to release, indemnify, and discharge East Coast Hui on behalf of myself, my spouse, my children, my heirs, assigns, personal representative and estate as follows.  


     1.  I acknowledge that surfing and other East Coast Surfing Camp Activities entail known an d unanticipated risks that could result in physical or emotional injury, paralysis, death or damage to myself, to property, or to third parties.  I understand that such risks simply cannot be eliminated without jeopardizing the essential qualities of the activities.


     The risks include, being hit by the equipment or other surfers on their boards which could result in cuts, bruises, abrasions, and concussions; hitting the bottom of the ocean; sprains; strains; broken bones; paralysis, even death; exhaustion; dehydration, sunburn; exposure to poisonous and/or carnivorous sea creatures; and accidental drowning.  

     Furthermore; East Coast Hui employees have difficult jobs, to perform.  They seek safety, but they are not infallible.  They might be aware of a participant's fitness or abilities.  The might misjudge the weather or other environmental conditions.  They may give incomplete warnings or instructions, and the equipment being used may malfunction.

     

     2.  I expressly agree and promise to accept and assume all of the risks existing in the activity.  My participation in the activity is purely voluntary, and I elect to participate in spite of the risks.


     3.  I hereby voluntarily release, forever discharge, and agree to indemnify and hold harmless East Coast Hui from any and all claims, demands, or causes of action, which are in any way connected with my participation in this activity or my use of East Coast Hui's equipment or facilities, including any such claims which allege negligent acts of omissions of East Coast Hui.  


     4.  Should East Coast Hui or anyone acting on their behalf, be required to incur attorney's fee and costs to enforce this agreement, I agree to indemnify and hold them harmless from all such fees and costs.


     5.  I certify that I have adequate insurance to cover any injury or damage I may cause of suffer while participating, or else I agree to bear the costs of such injury or damage myself.  I further certify that I am willing to assume the risk of any medial or physical condition I may have.  


    6.  In the event that I file a lawsuit against East Coast Hui, I agree to do so solely in the state of Massachusetts, and I further agree that the substantive law of Massachusetts shall apply in that action without regard to the conflict of law of rules of that state.  I agree that if any portion of this agreement is found to be void or unenforceable, the remaining portion shall remain in full force and effect.  


By signing this document, I acknowledge that if anyone is hurt or property damaged during my participation in this activity, I may by found by a court of lay to have waived my right to maintain a lawsuit against East Coast Hui and Robert C. Fenton, on the basis of any claim from which I have released them herein.


I have had sufficient opportunity to read this entire document.  I have read and understood it, and I agree to be bound by its term.  


Printed Name of Participant:_____________________________________________________________

Age:_____________________________

Sex:_____________________________

Permanent Address:_____________________________________________________________________

Phone Number:__________________________________________________________________________

Email Address:____________________________________________________________________________


PARENT'S OR GUARDIAN'S INDEMNIFICATION/SIGNATURE

(must be completed for participants under the age of 18)

In consideration of_____________________(minors name)being permitted by East Coast Hui to participate in its activities and to use its equipment and facilities, I further agree to indemnify and hold harmless East Coast Hui from any and all claims which are brought by, or on behalf of Minor, and which are in any way connected with such use or participation by Minor.

__________________________________________________________________________________________

Parent/Legal Guardian Signature              Printed Name                      Date




image4