
Group 2
Standard ActivitySummer 2021|#23279
Aug 2, 2021 - Aug 6, 2021
Age at least 6 yrs but less than 14y 11m, Mixed
CampsYouth
Activity locationFurman Park
Description
Camp Downey offers children an opportunity to make new friends, try new activities, and stay active. Parents will benefit knowing their children are in a safe, well-supervised environment that provides challenges and adventure to the children. Due to the COVID-19 pandemic, and to ensure the safety of participants and staff, we have made several changes to our typical day camp programs. Each camp will register 30 participants, but campers will remain in the same group of 15 children throughout the week. Campers must wear a face mask at all times, and social distancing will be enforced as much as possible. Campers may be registered for as many of the one-week sessions as they like. Price includes supervision, materials and craft supplies. Please note, there will be no large excursions or pool day excursions. Mini-trips are a possibility depending on county guidelines. Campers must bring their own sack lunch each day. Camp t-shirts will be available for an additional $10. Information is subject to change and will be updated as needed.
Activity meeting dates
Aug 2, 2021 - Aug 6, 2021
Weekdays7:00 AM - 6:00 PM
Instructor
Recreation Staff
More Information
SupervisorMonica Ortiz
Number of sessions5
Registration dates
From May 10, 2021
Program Waiver
City of Downey
Parks & Recreation Department
Program Consent Form
PLEASE PRINT
Name of Participant ________________________________________________
Birth Date: _______________ Gender: M or F
Address _______________________________________________________________________
City/State/Zip _______________________________________________________________
Home Phone:_______________________________ Cell Phone ___________________________
Work Phone ________________________________
Email: ___________________________________________________
Waiver, Release, Assumption of the Risk & Indemnification Agreement–
City of Downey Department of Parks & Recreation
In consideration for being permitted by the City of Downey Department of Parks & Recreation (City) to participate
in Department Program(s), I, on behalf of my minor child/myself, hereby waive, release, and discharge any and all claims
for damages for personal injury, death, communicable diseases, illness, virus, or property damage which my minor
child/myself has, or which may hereafter accrue to my minor child/myself, as a result of participation in said Program(s).
This release is intended to discharge in advance City, and City’s officers, employees, volunteers and agents from any and
all liability arising out of or connected in any way with my minor child’s/myself participation in Department Program(s),
even though that liability may arise out of active or passive negligence or carelessness on the part of the City, and/or the
City’s officers, employees, volunteers, agents and other participants of program. It is understood that the Department
Program(s) involves or may involve an element of risk and danger of accidents to my minor child/myself, and knowing
those risks I hereby assume those risks on behalf of my minor child/myself. It is further agreed that this waiver, release
and assumption of risk is to be binding on my heirs, successors and assigns.
I further agree for myself, my heirs, administrators, executors and assigns to indemnify, defend and hold harmless
City and City’s officers, employees, volunteers and agents from any loss, liability, damage, cost, or expense which each of
them may incur as a result of any injury, death or property damage that any third party may sustain as a result of the
negligence or willful misconduct of my minor child/myself while participating in the Department Program(s).
I hereby consent that my son/daughter/myself participate in the above named Department Program(s), and I
hereby execute this Waiver, Release, Assumption of the Risk & Indemnification Agreement on his/her/my behalf. I state
that the minor/myself named on this form is physically able to participate in said Department Program(s). I hereby agree to
indemnify, defend and hold harmless the City, and/or City’s officers, employees, volunteers and agents from any loss,
liability, damage, cost, or expense, which each of them may incur as a result of any injury, communicable disease,
illness, virus, death or property damage that said minor/myself may sustain while participating in the Department
Program(s).
I HAVE CAREFULLY READ THIS WAIVER, RELEASE, ASSUMPTION OF THE RISK & INDEMNIFICATION
AGREEMENT, HAVE HAD AN OPPORTUNITY TO ASK QUESTIONS REGARDING THIS AGREEMENT AND FULLY
UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A WAIVER, RELEASE OF LIABILITY, ASSUMPTION
OF THE RISK & INDEMNIFICATION AGREEMENT BETWEEN ME AND THE CITY OF DOWNEY AND I SIGN IT
FREELY AND VOLUNTARILY.
__________________________________________ _________________
Signature of Adult Participant or Parent/Legal Guardian Date
Print Name of Adult Participant or Parent/Legal Guardian: _________________________________
Side 1 – TURN OVER TO COMPLETE
Medical Release
In the event of an emergency, I, _______________________________, hereby designate an adult leader of the City of
Downey Department of Parks & Recreation as my agent with full authority to authorize emergency medical attention or
treatment and health services and care by any licensed physician or surgeon or any licensed hospital for my minor
child/myself whenever such treatment or care is required for any condition which endangers the life and/or limb of my
minor child/myself. (Please provide the medical/health insurance information below):
Family Physician:______________________________________ Telephone:_______________________
Medical Insurance Company:_____________________________ Policy No.________________________
Do you/your minor child have any medical conditions or allergies to medication(s)? If yes, what?
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Signature of Adult Participant or Parent/Legal Guardian Date
Print Name of Adult Participant or Parent/Legal Guardian:
PERSON(S) TO CONTACT IN CASE OF EMERGENCY
/ ( ) ( )
Name Relationship Cell Phone Home Phone
/ ( ) ( )
Name Relationship Cell Phone Home Phone
Photo Release
I understand that city representative may photograph or video record activities at City Recreation Programs
and/or events and participants. By registering and/or attending City recreation classes and events, you are
authorizing the City of Downey to use or publish any photographs or videos taken by the City showing your
participation or your child/children’s to promote classes and/or events on the City’s website, or any other future
City publications and/or flyers unless you otherwise decline.
Signature of Parent/Legal Guardian: ________________________________ Date: ___________
Retired
Share
Notes
Please remember to send a sack lunch with your camper each day and pack extra water if needed. Pick up after 6pm will result in a late fee of $10 for every 15 minutes late.
An emergency card must be on file prior to dropping your child off at camp.
Please read your parent manual for information regarding camp rules and regulations.
Only a 70% refund will be given for cancellation of camp after payment has been processed. NO REFUNDS will be given on/after the start of camp each week.