Participant Agreement Form

It Takes A Village! Kroka Family Camp

Step 1 of 11

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YOUR INFORMATION
STUDENT / PARTICIPANT INFORMATION
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Participant Agreement Form

It Takes A Village! Kroka Family Camp

Step 2 of 11

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Are you familiar with Kroka's unique philosophy and curriculum as explained in our parent handbook?
Kroka Expeditions awakens a connection to nature and spirit, and develops willpower for conscious living and compassionate service through adventure sports, community living, farming, and the practice of traditional and indigenous skills. At Kroka, students are exposed to a variety of outdoor adventure activities, including hiking, climbing, paddling, exploring, caving, skiing, biking, and more. In the course of a regular program, students might sleep outdoors in the open air, walk through the woods with bare feet, use sharp knives to carve a stick, gather edible wild berries and leaves, cook a meal over an open fire, and connect with the natural world in a powerful and authentic way that many modern people are quite unaccustomed to.

There are of course risks involved in all of these activities, but we believe that healthy risk taking is essential for the development of capable human beings. This important work is made possible only by the high level of trust and collaboration that we share between students, parents, teachers, and Kroka staff. In order to ensure this trust, we ask that families learn as much as possible about Kroka's philosophies and practices before choosing to participate.

Please initial below to indicate that you have read and understood the parent handbook which is published on our website.

Participant Agreement Form

It Takes A Village! Kroka Family Camp

Step 3 of 11

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Does this student have any ALLERGIES?
To foods? To medications? To insect stings or other environmental agents?
If so, please explain the symptoms and the severity of these allergies: ( MILD or SEVERE / LIFE THREATENING )
None? click here

Participant Agreement Form

It Takes A Village! Kroka Family Camp

Step 4 of 11

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Does this student have any SPECIAL DIETARY NEEDS OR RESTRICTIONS?
If so, please read Kroka's food policies which can be found on our website by clicking here.
Then please explain clearly the dietary needs, and indicate clearly whether they reflect a personal or spiritual choice, a mild allergy, a significantly uncomfortable allergy, or an experienced and documented life-threatening anaphylactic reaction.
None? click here

Participant Agreement Form

It Takes A Village! Kroka Family Camp

Step 5 of 11

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Is this student taking any regular MEDICATIONS?
lf so, please list medications and their purpose:

*All medications and vitamins will be held and administered by Kroka staff. Please provide written instructions regarding the dosage, frequency and side effects.

None? click here

Participant Agreement Form

It Takes A Village! Kroka Family Camp

Step 6 of 11

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Tell us any concerns you may have about your child's participation at Kroka:
Please write to us about any injuries or physical limitations, or any emotional, behavioral, or mental health issues, any sleep issues, substance abuse, history of infections, concerns about swimming ability, or anything else that you can let us know in advance to help our staff to make the program safe and enjoyable for everyone. Please note: failure to disclose significant medical or learning issues undermines our work and the safety of our programs, and we reserve the right to dismiss any student who arrives with undisclosed conditions.
None? click here

Participant Agreement Form

It Takes A Village! Kroka Family Camp

Step 7 of 11

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I understand that Kroka may take (and use) photographs or other recordings of my child.
Kroka Expeditions staff and volunteers will sometimes take photographs, audio, or video recordings of program participants and guests on our campus and during expedition programs. These images or recordings are usually shared with parents at the conclusion of a program, and a few of the very best items might become part of our published outreach materials, both online and in print. Also, sometimes students ask for help in keeping in contact with one another at the conclusion of a program, and we may share a printed page of basic student contact information towards that end.

Note: Kroka respects your privacy and confidentiality. We will never publish student names without parental permission, and we will never sell, trade, or share any personal or contact information about your family without your express permission.

IF YOU HAVE ANY CONCERNS OR SPECIFIC NEEDS FOR PRIVACY around images, recordings, or name and address contact information, please contact us directly via telephone ( 603-835-9087 ) to discuss how we can help accommodate you. We will be happy to help.

Participant Agreement Form

It Takes A Village! Kroka Family Camp

Step 8 of 11

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Do we have permission to treat your child in the event of an urgent medical need?
By initialing below I attest that this student has receieved an appropriate level medical care and attention, including a regular physical evaluation from a physician, physician's assistant, or nurse practitioner, within the past two years. There are no undisclosed medical conditions, including infectious diseases, cardiac or respiratory conditions, which would limit or preclude participation in Kroka's vigorous outdoor activities.

In the event of an emergency or non-emergency situation requiring medical treatment, I hereby grant permission for any and all medical and/or dental attention to be administered to this child, until such time as I can be contacted. This permission includes, but is not limited to, the administration of first aid, the use of an ambulance, and in case of a life-threatening emergency the administration of anesthesia and/or surgery, under the recommendation of qualified medical personnel.

Participant Agreement Form

It Takes A Village! Kroka Family Camp

Step 9 of 11

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Responsibility & Dismissal:
I understand that Kroka reserves the right to dismiss any participant whom staff believes presents a safety concern or medical risk, or is disruptive to the normal program activities, or deliberately conducts him/herself in a manner that is detrimental to the program, or arrives with undisclosed medical, behavioral, emotional or learning challenges. Use of alcohol, illegal drugs, tobacco products, or unauthorized electronic devices can be grounds for immediate dismissal from the program, in addition to harassment, sexual activity, bullying, or other socially exclusionary behavior.

I understand that if my child experiences a medical illness or emergency, or has unanticipated training, academic, or emotional support needs, or is dismissed early from the program, I (or my insurance company) will be fully responsible for all financial costs associated with any extra staff support, supplies, medications, medical and emergency services, or transportation logistics incurred as a result of my child's needs.

I also accept financial responsibility for the repair or replacement of any Kroka equipment that is lost or damaged while under my child's care during a Kroka program.

Participant Agreement Form

It Takes A Village! Kroka Family Camp

Step 10 of 11

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Liability Release Agreement: Please read carefully!
This Document informs you about your responsibilities and assumption of risks, and includes a release of liability, indemnification and surrender of certain legal rights. In consideration of the services of Kroka Expeditions and its agents, officers, employees, volunteers, independent contractors and all other persons or entities associated with it, other participants, sponsors, advertisers, and, if applicable, owners and lessors of premises used to conduct activities (hereafer, 'Releasees'), participant agrees as follows:

ACKNOWLEDGMENT AND ASSUMPTION OF RISKS: Kroka program activities may include a variety of outdoor wilderness adventure, farming, and community service activities. We acknowledge that these activities involve inherent and other risks, hazards and dangers. The following describes some, but not all of those risks, hazards and dangers: Farm chores and service projects: can include risks associated with activities such as weeding, digging, lifting, light construction and clean-up projects and the use of tools and equipment that can cause injury resulting from use, misuse or malfunction. Farm animals can move suddenly or behave in unpredictable ways that can cause injuries. Travel can be on foot or by motor vehicle, boat, bicycle, or other means and can be over rough and unpredictable terrain or via lakes and rivers, in snow, sleet, rain or other adverse weather conditions. Activities may take place in remote locations, several hours from medical facilities, causing potential delays in communication, transportation, evacuation and medical care. Wilderness living: Students will very likely go barefoot at times, and experience small cuts or abrasions to the feet. Students may be near an open fire and are subject to the risk of burns from flames or hot coals. Students will drink water from wells and natural springs, and will likely be offered raw, wild, or unprocessed foods, both from the wilderness (nuts, berries) or from the farm (produce, milk, eggs). Camp sites may be subject to high winds, falling trees and/or branches, floods, and other weather-related hazards. All students may experience brief periods of time, stationary, alone in the field (solos). Older students (14+), may have periods of unsupervised free time and/or periods of independent student travel. Outdoor adventure: Participants’ travel may be subject to lightning, strong winds, fast moving water, falling rocks, extremely hot or cold weather or cold water, snow and ice, fallen timber, stinging or disease carrying insects, poisonous plants, wild animals and other natural or man-made hazards. Water activities: include potential water obstacles or hazards such as boulders, trees, waterfalls, and holes, the risk of falling overboard, impacting the lake or river bottom, being swept into a river current or experiencing a boat capsize or collision. Human behavior and decision making, including, without limitation, the risk that a Kroka staff member, representative, volunteer or co-participant may misjudge a participant’s capabilities, health or physical condition, or misjudge some aspect of instruction, medical treatment, weather, terrain, water level, and the risk that participant’s mental, physical or emotional condition combined with participation in these activities could result in injury, damage, death or other loss. These and other risks, hazards and dangers may result in participants: falling, being struck, colliding with objects or people, experiencing vehicle or boat collision or capsize, reacting to high altitudes and weather conditions, becoming lost or disoriented, suffering gastrointestinal complications or allergic reactions. These and other circumstances may cause hypothermia, hyperthermia, dehydration, frostbite, drowning, altitude sickness, broken bones, paralysis, concussions or other injury, damage, death or loss. Participant (and Parent(s) of minors) assume and accept full responsibility for participant, for the inherent and other risks of these activities (both known and unknown) and for any injury, damage, death or other loss suffered by participant (and Parent(s) of minors), resulting from these risks, or resulting from participant's own negligence or other misconduct.

RELEASE AND INDEMNITY AGREEMENT: I, for myself, and for and on behalf of my family members, heirs, executors, representatives and estate, agree as follows:

1. to release and agree not to sue Kroka Expeditions or any above named Releasees, with respect to any and all claims, liabilities, suits or expenses (including attorneys' fees and costs) (hereafter collectively 'claim or claim(s)'), for any injury, damage, death or other loss in any way connected with my and/or my child's enrollment or participation in these activities, or use of Kroka equipment or facilities. I understand that in signing this document, I, anyone acting on my behalf, and my spouse and other family members surrender, to the fullest extent allowed by law, our respective rights to make a claim against Kroka (or above Releasees) as a result of any injury, damage, death or other loss suffered by me, my spouse, or any of my children.;

2. to defend and indemnify ('indemnify' meaning protect by reimbursement or payment) Kroka and Releasees with respect to all claim(s)brought by or on behalf of me or a family member for any injury, damage, death or other loss in any way connected with my or my child's enrollment or participation in these activities, or use of Kroka equipment and facilities.

This Release and Indemnity Agreement includes any losses caused or alleged to be caused, in whole or in part, by the negligence (but not gross negligence or willful, wanton or criminal misconduct), and includes claims for personal injury, property damage, wrongful death, loss of consortium, breach of contract or otherwise.

I have carefully read, understand and voluntarily sign this Document and acknowledge that it shall be effective and binding upon me and other family members, and my heirs, executors, representatives and estate.

Participant Agreement Form

It Takes A Village! Kroka Family Camp

Step 11 of 11

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Please check this box:
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Electronic Signature Authorization

By entering my name below, I testify that I have read this entire document and agree to be bound by it's terms. By applying my electronic signature to this agreement, whether on my own behalf and/or on the behalf of any minors, I agree that my electronic signature is the legally binding equivalent of my handwritten signature on paper. I will not, at any future time, claim that my electronic signature is not legally binding or enforceable. By electronically signing and submitting this agreement, I 1) acknowledge that I have read and fully understand the terms of the agreement; 2) voluntarily agree to be bound by this agreement; and 3) certify that I am 18 years of age or older. My signature applies to all pages of this contract. I understand that I will receive a Portable Document Format (PDF) version of this agreement after it is signed at the email address I have provided. I understand that if I wish to sign a paper copy of this document, I must contact Kroka Expeditions directly.