2023 Camp Days

1. Parent | Legal Guardian Info & Waivers

Dear parents and caregivers,

YES will be hosting four Camp Days this spring with our summer camp partners on the following dates and locations:

March 25, with Camp CYO at Alvarado Park
April 8, with OVY Camp at Pt. Pinole Regional Park
May 13, with Camp Loma Mar at Nicholl Park
May 20, with St. Dorothy's Rest at Miller Knox Regional Park

During Camp Days, approximately 40 youth, ages 8-17, enjoy a day of fun and interactive activities led by the YES team, community and summer camp partners!

Lunch and snacks are provided. To enroll your child(ren), please fill out this form.

Thank you,
The YES Team

Question Title

* 1. Which Camp Day will your child(ren) be attending?

March 25, with Camp CYO at Alvarado Park

April 8, with OVY Camp at Pt. Pinole Regional Park

May 13, with Camp Loma Mar at Nicholl Park

May 20, with St. Dorothy's Rest at Miller Knox Regional Park

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* 2. Parent or Legal Guardian's Information

First and Last Name *

What language do you prefer to be contacted in? (Spanish, English)

How do you prefer to be contacted? (Phone, text, email)

Cell Number *

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* 3. In case of an emergency, please list at least one person who will be available to support you, and/or your child(ren).

Contact 1 - First and Last Name

Contact 1 - Cell Number

Contact 1 - Relationship to Child(ren)

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* 4. Permission to photograph and videotape: YES Nature to Neighborhoods is a nonprofit organization. Program activities may be photographed, filmed, and/or audio recorded for educational, publicity, or fundraising purposes. Please indicate if you will allow your child(ren) to appear in recordings, videos, and/or photos without compensation (e.g., as part of brochures, slide shows or program websites).

Yes, I give my permission to YES and /or YES partners to photograph, film, or audio record my child(ren) during this event.

No, I do not give my permission to YES and/or YES partners to photograph, film, or audio record my child(ren) during this event.

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* 5. ACKNOWLEDGEMENT OF YES PROGRAM POLICIES: During YES Programs, the use, possession or distribution of ALCOHOL, CANNABIS, OR ANY ILLEGAL SUBSTANCES ARE PROHIBITED. PLEASE DO NOT BRING OR BRANDISH ANY WEAPONS. WE DO NOT TOLERATE ANY VERBAL, PHYSICAL OR MENTAL ABUSE, NOR ANY VERBAL OR PHYSICAL FIGHTS OR ILLEGAL BEHAVIOR. Individuals who do not respect these policies will be removed from YES Programming immediately. I affirm that I am the parent or legal guardian of the child(ren) listed in this application. I have read, understand, and acknowledge that by signing below, I accept the terms and conditions stated in this Acknowledgement of YES Program Policies and acknowledge that if I or my child(ren) engage(s) in any of the above during YES Programs, we will be asked to leave the program immediately, and that I will need to arrange for the transportation that will pick me and/or my child(ren) from this Activity.

First & Last Name of Parent or Legal Guardian:

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* 6. Please list the names, ages, and physical or mental conditions that we should be aware of of each child that plans to attend the Camp Day(s).

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* 7. I, the undersigned, as participant, or as parent or legal guardian of the child(ren) listed in this form, hereby assume full responsibility for all risk or injury or loss which may result from my or my child(ren)'s participation in this Activity, and give permission for my child(ren) to participate in this Activity. I hereby agree to hold harmless, release and forever discharge YES Nature to Neighborhoods (YES), its officers, directors, agents, and employees and its partners and their representatives from any and all claims and demands whatsoever which the undersigned, and any of them or any third party and their representatives or any person acting under their behalf have, or may have against YES and/or its partners by reason of any accident, illness, injury, or death to any person or persons, or damage to, loss of or destruction of property arising or resulting directly or indirectly from my or my child(ren)'s participation in this activity, and occuring during said participation or anytime subsequent there to regardless of whether said claims or demands arise out of negligence on the part of YES or its partners. The terms of this release shall serve as a release and assumption of risk for myself, my child(ren), heirs, executives, administrators, and for all of my family members. I understand, agree, and acknowledge that some activities in this program may be of a hazzardous nature and/or include physical and/or strenuous activity. I hereby assume all risk of such activities. Understanding this, I state to the best of my knowledge that I or my child(ren) listed on this form have no medical, physical, mental, or emotional health conditions which would hinder my or my child(ren)'s active participation in this Activity. In case of an emergency in which I am not able to give permission for medical treatment and my designated emergency contact cannot be reached, I authorize YES or its partners to obtain whatever medical treatment is deemed necessary for my or my child's welfare. In the case of my child, this authorization is given pursuant to the provision of Section 25.8 of the Civil Code of California. I further understand and agree that I will be financially responsible for all charges and fees incurred in the rendering of said emergency treatment, regardless of whether my medical insurance would cover such charges and fees.

First & Last Name of Parent or Legal Guardian: