Pumpkin Patch Kids Camp Summer Break 2023
Child’s Information
Name (First/Last): ___________________________________
Date of Birth (month/day/year): Any medical issues? Pokémon/WotC Account: ___________________________________
Parent/Guardian Information
Name (First/Last): ___________________________________
Email Address: ___________________________________
Home Phone Number: ___________________________________
Cell Phone Number: ___________________________________
Work Phone Number: ___________________________________
Address (street, city, state, zip): ___________________________________
Emergency Contact
Name (First/Last): ___________________________________
Relationship to Child: ___________________________________
Cell Phone Number: ___________________________________
Secondary Emergency Contact
Name (First/Last): ___________________________________
Relationship to Child: ___________________________________
Cell Phone Number: ___________________________________
STORE CREDIT ACCOUNT
We advise that parents fund a store credit account for their children for the purposes of purchasing snacks, drinks, entries, and accessories. Children get hungry or forget accessories needed for the event at home. If you would like to set up an account, please check the boxes below. To fund the account, you can stop into the store with your child.
( ) Yes, I would like to set up a store credit account for my child
This spending account should be used for (check all that apply):
( ) Snacks & Drinks
( ) Event Entries
( ) Accessories needed for events
( ) All merchandise
( ) No, I would not like to set up a store credit account for my child SELLING/TRADING-IN CARDS It is our policy to not buy cards or do trade-ins with children under 14 unless their parent/guardian is present. If you would like to allow your child to sell & trade cards to the store without your presence, please check a box below. ( ) Yes, my child has my permission to sell and/or trade-in cards to Free Range Pumpkins. ( ) No, my child DOES NOT have my permission to sell and/or trade-in cards to Free Range Pumpkins. PHOTO/VIDEO RELEASE Free Range Pumpkins maintains the right to take photographs or videos of anyone participating in our events. Please contact our management team if you specifically do not want to be included in this policy. Free Range Pumpkins has full and unrestricted publishing and uses rights of these photographs and videos including on our website and social media. LIABILITY WAIVER In exchange for participation in the activity of Kids’ Summer Break Activity Camp organized by Free Range Pumpkins, of 1525 S Bowen Road, Suite A, Pantego, Texas, 76013 and/or use of the property, facilities and services of Free Range Pumpkins, I agree for myself and for the members of my family, to the following:
1.AGREEMENT TO FOLLOW DIRECTIONS. I agree to observe and obey all postedrules and warnings, and further agree to follow any oral instructions or directions givenby Free Range Pumpkins, or the employees, representatives or agents of Free RangePumpkins.
2.ASSUMPTION OF THE RISKS AND RELEASE. I recognize that there are certaininherent risks associated with the above described activity and I assume fullresponsibility for personal injury to myself and (if applicable) my family members, andfurther release and discharge Free Range Pumpkins for injury, loss or damage arising outof my or my family’s use of or presence upon the facilities of Free Range Pumpkins,
whether caused by the fault of myself, my family, Free Range Pumpkins or other third parties. 3.INDEMNIFICATION. I agree to indemnify and defend Free Range Pumpkins against allclaims, causes of action, damages, judgments, costs or expenses, including attorney feesand other litigation costs, which may in any way arise from my or my family’s use of orpresence upon the facilities of Free Range Pumpkins.
4.FEES. I agree to pay for all damages to the facilities of Free Range Pumpkins caused byany negligent, reckless, or willful actions by me or my family.
5.APPLICABLE LAW. Any legal or equitable claim that may arise from participation inthe above shall be resolved under Texas law.
6.NO DURESS. I agree and acknowledge that I am under no pressure or duress to sign thisAgreement and that I have been given a reasonable opportunity to review it beforesigning. I further agree and acknowledge that I am free to have my own legal counselreview this Agreement if I so desire. I further agree and acknowledge that Free RangePumpkins has offered to refund any fees I have paid to use its facilities if I choose not tosign this Agreement.
7.ARM’S LENGTH AGREEMENT. This Agreement and each of its terms are the productof an arm’s length negotiation between the Parties. In the event any ambiguity is found toexist in the interpretation of this Agreement, or any of its provisions, the Parties, and eachof them, explicitly reject the application of any legal or equitable rule of interpretationwhich would lead to a construction either “for” or “against” a particular party based upontheir status as the drafter of a specific term, language, or provision giving rise to suchambiguity.
8.ENFORCEABILITY. The invalidity or unenforceability of any provision of thisAgreement, whether standing alone or as applied to a particular occurrence orcircumstance, shall not affect the validity or enforceability of any other provision of thisAgreement or of any other applications of such provision, as the case may be, and suchinvalid or unenforceable provision shall be deemed not to be a part of this Agreement.
CAMP DETAILS The cost for one week of camp is $175. On Mondays and Wednesdays we’ll be playing Dungeons and Dragons. On Tuesdays and Thursdays we’ll learn to play trading card games like Pokémon. On Fridays we’ll be painting miniatures and playing board games!Please be on time to pick up your child. If you have not arrived to pick up your child and cannot be reached by phone within 15 minutes of camp end time, we will call the emergency contact(s) listed on their enrollment forms. The Department of Social Services and/or the Pantego Police Department will be contacted if parents cannot be contacted or do not arrive within 45 minutes of store closing time. Late pickups will incur a late fee. The late fee is $20 for each half hour. If your child is picked up late on more than two occasions, Free Range Pumpkins reserves the right to suspend your child from further camp activities. No refunds will be given.
4.5 hours per session – 11:30am to 4:00pm Drop Off Time: No earlier than 11:00am Pick Up Time: No later than 4:30pm Dates of Sessions:
1st Day: Wednesday May 24, 2023 or Monday May 29, 2023 Last Day: Tuesday August 15, 2023
Run by experienced staff members Includes:
•Free Range RPG Player Journal•Set of dice•Dice bag•Trading Card Game Deck•Miniature•Bottle of water for each session•Bag of chips for each session
A Pokémon Trainer Club Account and a Wizards Account will be created for your child when
you first enroll them in camp. If your child already has these accounts, it will not be
necessary.
You may do this from home and bring in the information on your child’s first day.
Pokémon Trainer Club Account registration can be found at: https://club.pokemon.com/us/
pokemon-trainer-club/sign-up/
Wizards Account registration can be found at: https://myaccounts.wizards.com/login
I would like my child to participate in the following Free Range Pumpkins kids camp:
( ) Summer Break Camp – $175 per week payable at the start of each week
( ) 6 weeks of Camp – $925
( ) All 13 weeks of Camp – $2000.00
__I understand the fees stated above and that no further discounts or refunds will be given if my child misses one or more days.
__ I understand that I must not drop my child off more than 30 minutes prior to the published starting time. I understand that I must pick my child up promptly each day. Not picking my child up on time may incur a late fee and/or the removal of my child from further camp activities.
__ I have read this document and understand it. I further understand that by signing this release, I voluntarily surrender certain legal rights.
Name of Parent/Guardian Date
Signature of Parent/Guardian
STORE USE ONLY
Phone number(s) verified
Camp selected and paid; Receipt attached to form
Store Credit created; Receipt attached to form
Camp Trade-In Sheet attached to form
Pokémon and WotC accounts created
Amy N Kaplan 