Please fill out one application per camper.
All fields are required unless marked as (optional)
First Name
Last Name
Age by July 14, 2024
Date of Birth (mm/dd/yyyy)
Gender ---MaleFemale
Parent/Guardian Email
Confirm Email Address
Parent / Legal Guardian Address Street Address
City
State
Zip Code
Week Selection ---Week 1Week 3Week 1 & Week 3 Week 1: July 14 to July 21, 2024 Week 3: July 28 to August 4, 2024
T-Shirt Size (adult sizes only) ---x-smallsmallmediumlargex-large
AYF Junior Chapter (optional) ---Burbank (Varak)Crescenta Valley (Zartonk)Glendale (Roupen)Hollywood (Musa Ler)Montebello (Vahan Cardashian)North Valley (Artsakh)Orange County (Ashod Yergat)Pasadena (Nigol Touman)West San Fernando Valley (Sardarabad)Fresno (Kevork Chavoush)San Francisco (Rosdom)Houston (Dro)
How did you hear about us? (school, friend, social media, AYF, other)
This information is confidential and will be used in case of emergency
I hereby certify and authorize that my child is in good health and can travel to and participate in the Armenian Youth Camp / Armenian Cultural Foundation Sponsored Summer Camp program.
Parent / Legal Guardian Name
Parent / Legal Guardian Phone Number
Relation to Camper
Today’s Date
Emergency Contact #1
Name
Phone Number
Relationship
Emergency Contact #2
Phone number
Family Physician / Pediatrician Name
Family Physician / Pediatrician Phone Number
Health Insurance Carrier
Group Number
Agreement / Policy Number
I accept while my child is attending or traveling to or from the Armenian Youth Camp program, I hereby authorize the adult camp volunteer, Armenian Youth Camp staff member, or in his/her absence or disability, any adult accompanying or assisting him/her, to consent to the following medical treatment for said minor.
Has the camper ever had a history of: If yes, please explain.
---YesNo Dizziness after exercise? ---YesNo Seizure? ---YesNo High Blood Pressure? ---YesNo Asthma? ---YesNo Diabetes? ---YesNo Sleepwalking? ---YesNo Bed-wetting? ---YesNo Eating Disorder? ---YesNo Physical or Joint Problems? ---YesNo Emotional Difficulties in the past 12 months for which professional help was sought? ---YesNo Recent injury, illness or infectious disease? ---YesNo Chronic or recurring illness/condition? ---YesNo Frequent ear infections? Is there anything else we should be aware of? (optional) Please explain any "Yes" answers (optional):
Medication Allergies (optional) Food Allergies (optional) Other Allergies (Bee Stings, etc.) (optional)
Please list all current medications (optional): (Name, Dosage, Times Taken)
Does the camper have any dietary restrictions? ---YesNo If yes, please explain (optional):
Armenian Youth Camp was established to create a fun and safe environment that embraces the Armenian culture, encourages independence and nurtures lifelong friendships. Armenian Youth Camp maintains a zero tolerance policy for illegal behaviors and any behaviors that endanger children. Armenian Youth Camp reserves the right to prosecute unlawful infractions and dismiss Armenian Youth Camp Campers who violate the Code of Ethics and Conduct ("Code") outlined here. - Alcohol: The possession, consumption or use of alcohol is not permitted on the campgrounds for any purpose at any time. Any camper on camp property who is found to be under the influence of alcohol is subject to dismissal. - Possession of any of the following items are strictly prohibited and are grounds for the immediate dismissal of any Armenian Youth Camp Camper:
You understand and agree that your child is expected to exhibit appropriate behavior at all times while at Armenian Youth Camp and to obey all applicable laws while participating in or attending Armenian Youth Camp. This includes, generally, respect for other people, equipment, facilities or property. Armenian Youth Camp maintains a zero tolerance policy for bullying, harassment, sexual harassment, and gender-based harassment. Verbal acts, like name-calling, sharing of images and graphics, written statements, or other actions that may be physically threatening, harmful, or humiliating will not be tolerated. You agree that Armenian Youth Camp management, Staff, Directors, or volunteers may dismiss your child, without refund, should their behavior, in the opinion of organizers, endanger the safety of or negatively affect Armenian Youth Camp. You understand and agree that your child is responsible for taking care of their own personal belongings during Armenian Youth Summer Camp and, to the maximum extent permitted by law; neither Armenian Youth Camp nor the organizers are responsible for any personal item or property that is lost, damaged or stolen at Armenian Youth Camp. You understand and agree that the organizers reserve the right to cancel Armenian Youth Camp sessions in the event of weather (including, but not limited to, heat, tornadoes, earthquakes, fires, storms, lightning and floods), accidents, acts of war or terrorism, military conflicts or riots, or for any reason that would affect the safety and security of Armenian Youth Summer Camp participants and/or spectators or the feasibility of Armenian Youth Summer Camp to be held. In the event of such cancellation or any other cancellation for any reason, there will be no refund of your payment unless authorized by Armenian Youth Camp.
I hereby authorize Armenian Youth Camp to publish the photographs/videos taken of me and/or the undersigned minor children, and our names, for use in the Armenian Youth Camp website and social media accounts. I release Armenian Youth Camp from any expectation of confidentiality for the undersigned minor children and myself and attest that I am the parent or legal guardian of the children listed below and that I have the authority to authorize Armenian Youth Camp to use their photographs/videos and names. I acknowledge that since participation in publications and websites produced by Armenian Youth Camp is voluntary, neither the minor children nor I will receive financial compensation. I further agree that participation in any publication and website produced by Armenian Youth Camp confers no rights of ownership whatsoever. I release Armenian Youth Camp, its contractors and its employees from liability for any claims by me or any third party in connection with my participation or the participation of the undersigned minor children.
Waiver and Release of Liability of Activities at Armenian Youth Camp (Armenian Cultural Foundation) and Camp Sylvester. The following pertains to activities including but not limited to swimming, hiking, canoeing, archery, pellet guns, and rock climbing. WARNING: Armenian Youth Camp has taken reasonable steps to provide your child with appropriate equipment and/or skilled instructors so they can enjoy activities for which they may not be skilled. We wish to remind you these activities are not without risk. Certain risks cannot be eliminated without destroying the unique character of the activities. The same elements that contribute to the unique character of the activities can be causes of accidental injury. It is important for you to know in advance what to expect and to be informed of the inherent risks. ACKNOWLEDGMENT OF RISKS: I acknowledge that the following describes some, but not all of the risks: 1) Slips, trips or falls. 2) Risks associated with to swimming, hiking, canoeing, archery, pellet guns, and rock climbing: 3) Misuse of equipment or facilities. 4) Slips, trips or falls while climbing the rock wall. 5) Risks associated with climbing, or down-climbing: 6) Abrasion from or entanglement with ropes, canoes, oars or other equipment: 7) The presence, actions or falls of other participants. I understand the description of these risks is not complete and that other unknown or unanticipated risks may result in injury. ASSUMPTION OF RISK AND RESPONSIBILITY: In recognition of the inherent risks of the activity, my minor will engage in, I confirm that my child is physically and mentally capable of participating in the activities and/or using the equipment. My child will participate willingly and voluntarily and I assume responsibility for damages. RELEASE: In consideration of services or property provided, my minor children for whom I am parent, legal guardian or otherwise responsible, any heirs, personal representatives or assigns, due hereby release Armenian Youth Camp / Armenian Cultural Foundation, its principals, directors, officers, agents, employees, and volunteers, and each and every land owner, municipal and/or governmental agency upon whose property an activity is conducted, from all liability and waive any claim for damage arising from any cause whatsoever (except that which is result of gross negligence). Please read each of the following Rules and Regulations. The Armenian Youth Camp activities require that a parent or legal guardian of a participant under the age of 18 sign this waiver for that participant, after thoroughly explaining the guidelines to their children. 1. I acknowledge and understand that all climbers must be required to wear a helmet, all those canoeing must wear a lifejacket, archers and pellet gun activities require safety goggles. 2. I acknowledge and understand that the Armenian Youth Camp rentals, Pinecrest Lake and activities, hiking trails, archery/pellet gun range, and rock wall may ONLY be used while under the supervision of Armenian Youth Camp staff members. 3. I acknowledge and understand that there is no running, no bullying, no foul or derogatory language, near the Armenian Youth Camp premises, Pinecrest Lake, hiking trails, archery/pellet or archery range. 4. I acknowledge and understand that Armenian Youth Camp has the right to deny access to its swimming activities, Pinecrest Lake and activities, hiking trails, archery/pellet gun range or rock wall to any camper, permanently or for a specific period of time, for any failure to adhere to the Safety Guidelines and Regulations, or for any conduct that is viewed as unsafe, inappropriate, or unhealthy, including, but not limited to, horseplay or foul language. 5. I have read and understand the Acknowledgement of Risks, Assumption of Risk and Responsibility, Release of Liability and the Rules and Regulations for the Armenian Youth Camp.
FOOD ALLERGIES & SENSITIVITIES NOTICE Armenian Youth Camp strives to provide allergy neutral foods, however, Armenian Youth Camp is unable to accommodate specific dietary restriction.
MEDICAL TREATMENT CONSENT WAIVER You represent and warrant that your child is in sufficient physical condition to safely participate in Armenian Youth Summer Camp, and have no medical conditions that would make their participation in Armenian Youth Summer Camp more hazardous. You consent to medical care and transportation in order to obtain treatment in the event of injury to your child and understand that this Agreement and Waiver extends to any liability arising out of or in any way connected with the medical treatment and transportation provided in the event of an emergency and/or injury. You understand that no medical care may be available, but if it is, you assume liability for any and all medical expenses incurred as a result of your child’s participation in Armenian Youth Summer Camp (where such medical expenses are not provided on a free of charge basis by any medical services organizations, clinics, or hospitals), including, but not limited to ambulance transport, hospital stays, physician, and pharmaceutical goods and services. Your child must observe and obey all posted rules and warnings, to follow any instructions or directions provided to them by Armenian Youth Camp management, Staff and volunteers, and to abide by any decision of any Director relative to their ability to safely participate in or attend Armenian Youth Camp.
Armenian Youth Camp / Armenian Cultural Foundation Participation Agreement This under California law. Any future disputes between the parties will be resolved first by mediation and, if the shall be governed and interpreted. Mediation does not resolve the matter, by final and binding arbitration with JAMS in San Francisco, CA. In the event of a dispute, if the parties are deadlocked on a matter for more than fifteen (15) days, they agree to submit to mediation before a neutral mediator with the intent to conduct the mediation no later than thirty (30) days after submission by a party, and if the mediation is unsuccessful then proceed to binding arbitration to be conducted in accordance with the streamlined arbitration proceedings set forth in the rules of JAMS. The parties will share the expenses of any mediator and arbitrator, provided that the arbitrator may award costs and reasonable attorneys’ fees to the prevailing party in the arbitration.
Parent Name
Name of Camper
Date
