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** REGISTRATION IS CURRENTLY OPEN** 

The Fire & Life Safety Camp is for children ages 6 through 8. The Camp will be held Monday, June 15th through Friday, June 19th from 8:30 a.m. to 11:30 a.m. each day. The cost to participate is $50 per child.  

For more information about the camps:
Kids' camp opportunities

 

The Fire & Life Safety Camp is for children ages 6 through 8. The Camp will be held  Monday, June 15th through Friday, June 19th from 8:30 a.m. to 11:30 a.m. each day. The cost to participate is $50 per child. Camp will be held at the Cedar Rapids Fire Department Central Fire Station, 713 1st Avenue SE.

 

Session Attending:
 Fire & Life Safety Camp, June 15th - 19th 8:30am - 11:30am
   
Child's First Name:
Child's Last Name:
Parent's First Name:
Parent's Last Name:
Address:
Address Line 2:
City or Town:
State or Province:
Zip or Postal Code:
Home Phone:
Age:
Date of Birth:
Child's School:
Grade Entering:
Emergency Contact:
Emergency Phone:
Medical Conditions:
T-Shirt Size:
Email:
Additional Information:

Release, Waiver, and Hold Harmless Permission to Participate ("RELEASE")

THE CITY OF CEDAR RAPIDS, IOWA REQUIRES THAT THIS RELEASE BE SIGNED BEFORE PARTICIPATION IN A CITY SPONSORED ACTIVITY. IF THIS FORM IS NOT SIGNED, YOU OR YOUR CHILD WILL NOT BE ALLOWED TO PARTICIPATE. IT IS A WAIVER OF RIGHTS. DO NOT SIGN IF YOU HAVE ANY QUESTIONS.

If the participant is a minor, both parents must sign this RELEASE. In the case of a single-parent home, the custodial parent must sign. If you are registering your child electronically, completion of the registration will be considered your consent and agreement with this document.

1.     You, for yourself and on behalf of your child hereby agree to release, waive, and hold harmless the City of Cedar Rapids, Iowa, its officers, agents, employees, volunteers, and, if applicable, contractors, sponsors, advertisers, owners and lessors of premises on which the activity takes place (Collectively referred to as "RELEASEES"), from any and all liability arising from participation in the following activity:

CEDAR RAPIDS FIRE/POLICE DEPARTMENTS – SAFETY CAMP

You agree that by signing this RELEASE you hereby agree to release, discharge, and covenant not to sue the RELEASEES from and for all liability, claims, demands, losses, or damages on your account caused or alleged to be caused in whole or in part by the negligence of the "RELEASEES" or otherwise, including negligent rescue operations; and you further agree that if, despite this release, waiver of liability, and assumption of risk you, or anyone on your behalf, make a claim against any of the RELEASEES, you will indemnify, save, and hold harmless each of the RELEASEES from any loss, liability, damage, or cost which any may incur as the result of such claim.

You acknowledge that you have read this RELEASE and understand that you have given up substantial rights by signing it, and have signed it freely and without any inducement or assurance of any nature, and intend it be a complete and unconditional release of all liability, including any liability alleged to be caused by the negligence of the RELEASEES, to the greatest extent allowed by law and agree that if any portion of this agreement is held to be invalid the balance, notwithstanding, shall continue in full force and effect.

2.     This RELEASE waives all claims, known or unknown arising out of participation in the activity, including injury or death to self, and damage to property, however, such claim may arise, including acts of negligence such as but not limited to negligent care, supervision, or control. This RELEASE waives any claims against the RELEASEES arising from the actions of any other participant in the activity. Further, this RELEASE covers all activities immediately before and after participation in the City Sponsored Activity, including transportation to and from the event and waiting for rides after the event.

3.     Participation involves a risk of injury. By signing this form, you represent that you have considered the risks of participation in the activity, have obtained any medical clearance necessary to participate, and are able to participate without harm to yourself or others. Any equipment or materials provided to the participant in conjunction with the activity shall only be used with due care for others, the equipment, and the surroundings.

4.     In the event of injury, program supervisors shall administer basic first aid, and shall summon emergency services via 911. Supervisors are not trained to provide detailed medical care, and shall not, without prior agreement, provide medications. All costs of emergency care are the responsibility of the participant/ participant’s legal guardian(s). NO INSURANCE IS PROVIDED BY THE CITY FOR INJURY TO PARTICIPANTS.

5.     Parents or others may take audio or video recordings of the participants. You agree that photos or videos may be used in promotional materials produced by the City to encourage participation in the activity.

6.     You agree to follow all rules of conduct established in conjunction with the activity. Failure to follow the rules will result in your removal from the activity, and you agree that any program fees paid will be kept and not refunded. In the event of a problem while engaged in the activity, notify the activity manager/supervisor.

7.     This Release is given in partial consideration of your being allowed to participate in the activity described and binds yourself, your personal representatives, and any heirs or assigns.

I HAVE READ THIS DOCUMENT CAREFULLY, AND UNDERSTAND IT. I AM SIGNING THIS FREELY AND WITHOUT RESERVATION OR CONDITION.

Dated this day of  

 

Typing your name in this box and your birth date represents your signature

Parent/Guardian (required):
Birthday
Parent/Guardian:
Birthday:
     
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