association · • piraguismo en el en o viernes 27 de julio • celebracion de clausura en...

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ENO R I V E R F I E L D STATION www.enofieldstation.orgD

Estudiantes Edades 12-17 anos Julio 23-27 de 2018

Nasi a L o s i n t e r e s a d o s t i e n e n e n v i a r e m o s u n a c a r t a o u n R i v e r F i e l d S t a t i o n . Guarde l i s t a d e l a s c o s a s q u e n e c e s t a n

el 31 de Mayo p a r a c o m p l e t a r y e n v i a r l o q u e s e i n d i c a e n l a s i g u i e n t e l i s t a . L e m e n s a j e d e c o r r e o e l e c t r o n i c o c o n f i r m a n d o q u e e l n i f i o h a s i d o a c e p t a d o e n E n o esta paglna como referenda. E n J u n i o s e l e s e n v i a r a a l o s c a m p i s t a s s u s c r i t o s u n a

l l e v a r e i n f o r m a c i o n s o b r e t r a n s p o r t e .

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S o l i c i t u d f i r m a d a p e r l o s p a d r e s o t u t o r e s C u o t a d e s o l i c i t u d : $ 2 0 a e n v i a r j u n t o c o n e l f o r m u l a r i o ( e l p a g o c o m p l e t o d e b e r a h a c e r s e e f e c t i v o a n t e s d e l 3 0 d e J u n i p )

u s o d e c a n o a s d e F r o g H o l l o w O u t d o o r s f i r m a d a p o r l o s p a d r e s o t u t o r e s o p c i o n a l

C a d a d i a d e l E n o R i v e r F i e i c n a t u r a l e z a , y a p r e n d i e n d o i n c l u y e n : i n v e s t i g a c i o n e s t i e m p o p a r a d i v e r t i r s e , y p r i o y e c t o s

G r a c i a s p o r p r e s e n t a r e s t a ; ; o l i c i t u d p a r a e l Eno River Field Station. j E s p e r a m o s t e n e r u n a g r a n s e m a n a e s t e j u l i o e n e l r i o E n o ! E s t a m o s s e g u r o s d e q u e s u h i j o r e c i b i r a i n s t r u c c i o n y s u p e r v i s i o n p r o f e s i o n a l d e l a m a s a l t a c a l i d a d g r a c i a s a l a g r a n e x p e r i e n c i a d e n u e s t r o p e r s o n a l y d e q u e s e l a p a s a r a m u y b i e n c o n o c i e n d o n u e v o s a m i g o s y d i s f r u t a n d o d e l rio E n o .

S t a t i o n e s d i f e r e n t e p e r o i n c l u y e m u c h o t i e m p o a l a i r e l i b r e , e x p l o r a n d o l a d e n c i a m i e n t r a s t r a b a j a n c o n e s p e c i a l i s t a s d e c i e n c i a s n a t u r a l e s . Las a c t i v i d a d e s

p i f a c t i c a s d e c i e n c i a y l a n a t u r a l e z a , t i e m p o l i b r e p a r a e x p l o r a r y d e s c u b r i r e l r i o E n o , d e c i e n c i a y c o n s e r v a c i o n p a r a e l a r e a n a t u r a l .

G r a c i a s a l o s g e n e r o s o s B u r r o u g h s W e l l c o m e p a r a m a t e r i a l e s p a r a s u u s o d u i . E n o , u n c u a d e r n o y l a p i c e s , r e c i b i r a n u n a l m u e r z o y u n a

f o n d o s p r o p o r c i o n a d o s p o r e l P r o g r a m a d e E n r i q u e c i m i e n t o p a r a l a C i e n c i a d e l l s t u d i a n t e s , c a d a c a m p i s t a d e l E n o R i v e r F i e l d S t a t i o n r e c i b i r a u n a m o c h i l a c o n

d u r a n t e e l c a m p a m e n t o , i n c l u y e n d o u n a b o t e l l a d e a g u a r e u s a b l e , u n a p a n o l e t a d e l u n a c a m i s e t a d e E n o R i v e r F i e l d S t a t i o n , y c o m i d a . T o d o s l o s d i a s l o s n i f i o s m e r i e n d a s a l u d a b l e . T a m b i e n e s t a i n c l u i d o e l a l q u i l e r d e l a s c a n o a s

Enviar a: E n o R i v e r A s s o c i a t i o n E n o R i v e r F i e l d S t a t i o n 4 4 0 4 G u e s s R o a d D u r h a m , N C 2 7 7 :

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Informacion importante LUGAR: F i e l d S t a t i o n s e e n d u e n t r a H i l l s b o r o u g h , N C 2 7 2 7 8 ( a c ^ v e r t e n c c o d i g o p o s t a l " 2 7 2 4 3 " )

e n e l C o n f l u e n c e N a t u r a l A r e a s i t u a d o e n 4 2 1 4 H i g h l a n d F a r m R d , i a : e n a l g u n o s a p p s d e m a p a s l a d i r e c c i o n a p a r e c e c o m o " E f l a n d " c o n u n

OPCIONES DE TRANSPORTE 1 . H a b r a t r a n s p o r t e

1 1 3 C a l l e M a y o , r e g r e s a r a a l a s E T o d o s l o s d I a s , 8 - . 4 5 A M a l a s 9 : i L o s e s t u d i a n t e s

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d e a u t o b u s d i s p o n i b l e d i a r i a m e n t e d e H i l l s b o r o u g h C o m m o n s S h o p p i n g C e n t e r , H i l l s b o r o u g h , N C 2 7 2 7 8 . T o d o s l o s d i a s , e l a u t o b u s l l e g a r a a l a s 8 : 3 0 A M y : 3 0 P M a l H i l l s b o r o u g h C o m m o n s ,

p u e d e d e j a r s u s n i n o s e n e l e s t a c i o n a m i e n t o d e l C o n f l u e n c e N a t u r a l A r e a d e s d e l a s O O A M y p u e d e r e c o g e r l o s d e s d e l a s 5 : 0 0 P M a l a s 5 : 3 0 P M .

c o n u n a l i c e n c i a d e m a n e j a r p u e d e n m a n e j a r s u s c a r r o s y e s t a c i o n a r e n e l d e l C o n f l u e n c e .

al nifio: $ 5 . 0 0 p o r c a d a d i e z m i n u t o s p a s a d a s l a 5 : 3 0 s i r e c o g e a l c a m p i s t a e n e l H i l l s b o r o u g h C o m m o n s .

H O R A R I O D I A R I O (exduyendo la actividad opdonal nodurna del miercoles) 8 : 3 0 A u t o b u s e n e l H i l l s b o r o u g h C o m m o n s 8 : 4 5 - 9 L e g a d a e n a u t o a l C o n f l u e n c e N a t u r a l A r e a 9 : { X ) C i r c u l o d e a p e r t u r a 9 : 1 5 A c t i v i d a d e s d e l a m a f i a n a 1 2 : 3 0 A l m u e r z o y t i e m p o l i b r e 1 : 3 0 A c t i v i d a d e s d e l a t a r d e 4 : 4 5 C i r c u l o d e c i e r r e 5 : 0 0 T o m a r e l a u t o b u s d e r e g r e s o a H i l l s b o r o u g h C o m m o n s 5 - 5 : 3 0 R e c o g i d o d e n i n o s e n e l C o n f l u e n c e N a t u r a l A r e a

El miercoles, 25 de julio l o s e s t u d i a n t e s t i e n e n l a o p c i o n d e q u e d a r s e p a r a l a s a c t i v i d a d e s e n l a n o c h e d e l o s a n i m a l e s d e l b o s q u e o s c u r o . L o s p r o g r a m a s t e r m i n a n a l a m e d i a n o c h e y l o s e s t u d i a n t e s p u e d e n a c a m p a r e n e l p a b e l l o n , o p u e d e n t r a e r t e n d a s d e c a m p a n a p a r a c a m p a r , o p u e d e n v o l v e r a c a s a . L o s e s t u d i a n t e s s e p u e d e n t r a e r s u s s a c o s d e ( k o r m i r c o n s u p r o t e c t o r i m p e r m e a b l e , o n o s o t r o s p o d e m o s p r o v e e r l o s .

El viernes, 27 de julio, l o s R i v e r c e r c a d e T r e y b u r n e r r i 'os E n o y F l a t s e u n e n p a r j i a d m i n i s t r a c i o n d e i a c a l i d a J

^ l u m n o s v i a j a r a n e n a u t o b u s d e s d e e l C o n f l u e n c e h a s t a la r a m p a b a r c o d e l E n o e l C o n d a d o D u r h a m . A l i i n o s i r e m o s d e c a n o a s a l a r e a d e l o s t r e s r i o s d o n d e l o s f o r m a r e l R i o N e u s e . C o m e r e m o s a l m u e r z o e n e l r i o y h a r e m o s p r o g r a m a s d e l a d e l a g u a y d e t i e r r a s p u b l i c a s .

El viernes, 27 de julio, t e n d r e m o s j l n v i t a m o s c o r d i a l m e n t e a l a s 3 : 4 5 y t e r m i n a r e m o s i n f o r m a c i o n s o b r e l a c e l e b i f a c i o n

n u e s t r a celebracion de clausura del campamento. : o d a s l a s f a m l l i a s d e l o s c a m p i s t a s a u n i r s e a n u e s t r a c e l e b r a c i o n ! E m p e z a r e m o s a

a p r o x i m a d a m e n t e a l a s 4 : 4 5 . C u a n d o s e a c e r q u e l a f e c h a , e n v i a r e m o s m a s

D a v e C o o k , C o o r d i n ^ d o r d e E d u c a c i o n ~ ( 9 1 9 ) 6 2 0 - 9 0 9 9 , x 2 0 4 w w w . e n o f i e l d s t a t i o n . o r g

e n o f i e l d s t a t i o n @ e n o r i v e r . o r R

R I V E R A S S O C I A T I O N

Nombre del estudiante

Apel ido A p o d o _

E N O R I V E R F I E L D S T A T I O N Solicitud de 2018

Julio 23-27, 2018

Nombre Segundo nombre

N o m b r e d e l o s p a d r e s :

C o r r e o e l e c t r o n i c o :

D i r e c c i 6 n ( e s ) p o s t a l :

lnformaci6n de contacto d e los padres/tutores:

T e l e f o n o p r i n c i p a l ( j -

T e l e f o n o s e c u n d a r i o ( -

T e l e f o n o a l t e m a t i v o ( ) -

P e r s o n a d e c o n t a c t o



F e c h a d e n a c i m i e n t o d e l n i f i o

G r a d o e s c o l a r e n 2 0 1 7 / 2 0 1 ^

E s c u e l a

J /_

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E d a d e n j u l i o d e 2 0 1 8 ,

T a l l a d e c a m i s e t a ( r o d e a r c o n u n c i r c u l o ) J u v e n i l L A d u l t o S A d u l t o M A d u l t o L A d u l t o X L A d u l t o X X L

d E x i s t e a l g u n a m o d i f i c a c i o r i e d u c a t i v a u o t r a c o n s i d e r a c i o n e s p e c i a l q u e e l p e r s o n a l d e b a t e n e r e n c u e n t a p a r a

e l n i f i o ? S i N o

d P a r t i c i p a r a s u e s t u d i a n t e (n e l p r o g r a m a o p c i o n a l l a n o c h e d e l m i e r c o l e s ? S i N o

d A c a m p a r a l a n o c h e d e m i e s r c o l e s ? S i N o

m i e r c o l e s , n e c e s i t a r a n u n s a c o d e d o r m i r ? Sf N o d S i e l e s t u d i a n t e a c a m p a e l

Companeros de campamento: Si su nifio prefiere estar en un grupo con algun o algunos amigos, por favor escribe su(s) nombre(s) aqpi:

^ ( g r u p o s d e c a m p a m e n t o s e f o r m a n p o r e d a d / g r a d o )

D a v e C o o k , C o o r d i n a d o r d e E d u c a c i o n ~ ( 9 1 9 ) 6 2 0 - 9 0 9 9 , x 2 0 4 ~ e n o f i e l d s t a t i o n @ e n o r i v e r . o r g w w w . e n o f i e l d s t a t i o n . o r g

Facilite la siguiente infornfiacidn sobre su seguro medico.

C o m p a n i a N o m b r e d e l t i t u l a r d e l a p o l i z a

N o . d e p o l i z a T e l e f o n o

Designe a otra persona autorizada para recoger al nifio en caso de emergencia:

N o m b r e R e l a c i o n

T e l e f o n o p r i n c i p a l ( .

C o r r e o e l e c t r o n i c o :

T e l e f o n o s e c u n d a r i o (_

d Q u i e n e s e l m e d i c o d e l n i n o ? T e l e f o n o (_

( L T i e n e e l n i f i o a l g u n p r o b l e f n a m e d i c o ?

S i e s a s i , d c u a l e s ?

Sf No

d T o m a e l n i i i o a l g i i n m e d i c a m e n t o ?

S i e s a s i , d c u a l e s ? d C u a n d o s e l o t o m a ? _

S i N o

d T i e n e e l n i f i o a l g u n a a l e r g i a a c o m i d a s o m e d i c i n a s ?

S i e s a s i , d C u a l e s ? .

S i N o

d T i e n e e l n i f i o a l g u n a r e s t r i c c i o n a l i m e n t a r i a ? S i e s a s i , d c u a l e s ?

S i N o

iHay becas disponibles! S e o f r e c e n b e c a s d e a y u d a a l o s n i n o s s u s c r i t o s a l P r o g r a m a F e d e r a l d e E s t a m p i l l a s o C u p o n e s d e A l i m e n t o s o a l p r o g r a m a d e a l m u e r z o g r a t i s o a p r e c i o r e d u c i d o d e s u e s c u e l a . C o m p l e t e l a s o l i c i t u d d e b e c a y e n v i e l a j u n t o c o n e l f o r m u l a r i o c o m p l e t a d o . Le n o t i f i c a r e m o s s i s e l e c o n c e d e la a y u d a . D e b e r a p a g a r l a c u o t a d e s o l i c i t u d d e s p u e s d e q u e e l n i f i o r e c i b a l a b e c a . E n c o n t r a r a m a s d e t a l l e s e n l a s o l i c i t u d d e b e c a .

Las fundaciones que financian iWalk q u i e r e n s a b e r q u e e s t a m o s i n c l u y e n d o u n a c o m u n i d a d d i v e r s a . N o e s n e c e s a r i o , p e r o n o s a y u d a r f a s i u s t e d i n d i c a l a r a z a / e t n i a d e s u h i j o a q u i

Como supieron de E n o R i v ^ r F i e l d S t a t i o n ? P o r f a v o r , m a r q u e t o d o s l o q u e a p l i c a n :

A n u n c i o d e P e r i o d i c o _ A d v e r t e n c i a d e E s c u e l a _ j W a l k o E n o S i t i o W e b O t r o C a m p a m e n t o V e r a n o S i t i o W e b _ N o t i c i a d e V e c i n d a d P o s t a l _ O t r o ( D e s c r i b e p o r f a v o r )

C a r t e l R a d i o A m i g o E n o M e s a d e A c t i v i d a d


a i r e

Dispensas y autorizaciones N o s o t r o s , l o s a b a j o c o n f i r m a m o s q u e s o m o s c o n s c i e n t e s d e l t i p o F i e l d S t a t i o n . T a m b i e n c o n f i r m a m o s o m e n t a l e s d e l n i n o . A u t o r i z a m o s a c t i v i d a d e s d e l c a m p a m e n i o S t a t i o n i m p l i c a r i e s g o s c o n 4 ) c i d o s l o s j u e g o s y a c t i v i d a d e s a l a c t i v i d a d e s d e c u a l q u i e r n o r m a s y r e g l a s d e l c a m p a r ^ e n t o r e g l a s . N o s c o m p r o m e t e m c ^ s d e l c a m p a m e n t o c o n t r a d e n u e s t r o h i j o . S i s e r e q u i r i e r a l a b o r a t o r i o , e t c . ) , e n t e n d e m o s m e d i c o e l e g i d o p o r e l p e r s o n a l t r a t a m i e n t o n e c e s a r i o . D a m o s l a E n o R i v e r A s s o c i a t i o n l a s d e t e l e f o n o s e o f r e z c a c o m b

f i r m a n t e s ( p a d r e s o t u t o r e s ) d e l n i f i o q u e a p a r e c e e n e l f o r m u l a r i o d e i n s c r i p c i o n .

Firma del padre/tutor:_

d e a c t i v i d a d e s e n l a s q u e p a r t i c i p a r a m i h i j o d u r a n t e s u p a r t i c i p a c i o n e n E n o R i v e r q u e h e m o s r e v e l a d o t o d a s l a s a f e c c i o n e s , p r o b l e m a s o d i f i c u l t a d e s f i s i c a s

a l p e r s o n a l d e E n o R i v e r F i e l d S t a t i o n a q u e t r a n s p o r t e a l n i i i o a l a s . E n t e n d e m o s q u e l a p a r t i c i p a c i o n d e n u e s t r o h i j o e n e l p r o g r a m a E n o R i v e r F i e l d

y d e s c o n o c i d o s q u e p o d r i a n r e s u l t a r e n l e s i o n e s d e b i d o a la n a t u r a l e z a d e l i b r e . D e b i d o a l p o s i b l e r i e s g o q u e p a r a l o s n i n o s i m p l i c a s u p a r t i c i p a c i o n e n l a s

c a j n p a m e n t o i n f a n t i l , e n t e n d e m o s l a i m p o r t a n c i a d e q u e n u e s t r o h i j o c u m p l a l a s . H e m o s p e d i d o a l n i n o q u e r e s p e t e a l p e r s o n a l y c u m p l a d i c h a s n o r m a s y

a e x o n e r a r y e x i m i r d e t o d a r e s p o n s a b i l l d a d a E n o R i v e r A s s o c i a t i o n y a l p e r s o n a l r e c l a m a c i o n , d e m a n d a o d e r e c h o d e d e m a n d a r e l a c i o n a d o s c o n l a p a r t i c i p a c i o n

s e r v i c i o s m e d i c o s e x t e r n o s ( v i s i t a s a l m e d i c o , r a d i o g r a f i a s , p r u e b a s d e q u e s e r e m o s r e s p o n s a b l e s d e s u p a g o . P o r e l p r e s e n t e d a m o s p e r m i s o a l d e E n o R i v e r F i e l d S t a t i o n p a r a q u e h o s p i t a l i c e a l n i f i o o l e s u m i n i s t r e e l

n u e s t r o p e r m i s o p a r a : ( 1 ) Q u e s e u t i l i c e n e n l a p u b l i c i d a d d e l c a m p a m e n t o y d e f o t o g r a f i a s y v i d e o s e n l o s q u e a p a r e z c a e l n i f i o ; ( 2 ) Q u e n u e s t r o n o m b r e y n u m e r o

r e f e r e n d a a f u t u r e s e s t u d i a n t e s ( m a r q u e l a s o p c i o n e s 1 o 2 s i n o d a s u p e r m i s o ) .

Fecha:

Cuota de solicitud: Todas las famllias deberan pagar una cuota de inscripcion de $20 al enviar la solicitud. Este dineito no es reembolsable.

Cantidad total de $^20 el 30 de junio, 2018

Pago con tarjeta de cr^itp:

N o m b r e d e l t i t u l a r :

N o . d e t a r j e t a

Cuota del campamento 1 semana $ 2 0 0

Cuota de solicitud* $ 2 0

Total adeudado $220

Total pagado ($20 o $220)

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F e c h a d e v e n c i m i e n t o :

F i r m a :

C o d i g o p o s t a l

Los cheques o giros bancarios s e h a r a n p a g a d e r o s a l a Eno River Association.

E n v i e e l f o r m u l a r i o c o m p l e

Eno River Field Station, En^

a d o y e l p a g o ( i n c l u i d a l a c u o t a d e s o l i c i t u d o t o t a l p a g a d o ) a :

River Association, 4404 Guess Rd., Durham, NC 27712


Eno River Field Station Sciiolarship Application Solicitud para reduccion de tarifa de Eno River Field Station

Politicas de reduccion E n o R i v e r A s s o c i a t i o n e s p e c i a l e s , a la m a y o r p a r t i c i p a r e n l o s p r o g r e e s t a b l e c i d a c o n e l o b j e ^ El p e r s o n a l d e l i W a l k

Tarifas del programa: A l o s i n d i v i d u o s q u e c a q u e c a n c e l e n u n 1 0 % (I

de tarifas e s t a c o m p r o m e t i d a a h a c e r d i s p o n i b l e s l o s p r o g r a m a s , a c t i v i d a d e s y e v e n t o s ( p a n t i d a d d e c i u d a d a n o s p o s i b l e . Es n u e s t r a i n t e n c i o n q u e a n a d i e s e l e i m p i d a

m a s p o r n o p o d e r p a g a r l a t a r i f a p l e n a . P o r l o t a n t o , e s t a p o l i t i c a h a s i d o i v o d e a t e n d e r l a s n e c e s i d a d e s d e i n d i v i d u o s o f a m l l i a s c o n r e c u r s o s l i m i t a d o s .

E n o m a n t e n d r a d i c h a i n f o r m a c i o n c o m o e s t r i c t a m e n t e c o n f i d e n c i a l . t h e

i f i q u e n p a r a u n a r e d u c c i o n d e t a r i f a s n o r m a l m e n t e s e l e s p e d i r a ) 2 0 A p p l i c a t i o n F e e s o l a m e n t e ) o 5 0 % c o s t o t o t a l d e l p r o g r a m a b a s a n d o s e

e n e l t a m a n o y l o s i n g r e s o s d e s u h o g a r , r e l a t i v a a l a E s c a l a d e E l e g i b i l i d a d p a r a A s i s t e n c i a F i n a n c i e r a q u e s e m u e s t r a a c o n t i n u a c i o n . R e v i s e m a s a b a j o " C i r c u n s t a n c i a s F i n a n c i e r a s " p a r a q u e c o n o z c a l a s e x c e p c i o n e s a e s t a p o l i ' t i c a .

Escala de eligibilidad Dara asistencia financiera Numero de Miembros delhogar

Cantidat la famili 50% ($1

1 Max. que recibe a, Paga tarifa de )0)

Cantidad Max. que recibe la familia, Paga Application Fee ($20) solamente

Marque aqui si recibe beneficios del Departamento de Servicios Sociales. Marque todas las que apliquen:

SNAP (Cupones para alimentos) Medicaid

1 $ 2 2 , 3 1 1 $ 1 5 , 6 7 8



2 $ 2 0 , 0 4 4 $ 2 1 , 1 1 2



3 $ 3 7 , 7 7 7 $ 2 6 , 5 4 6



4 $ 4 5 , 5 1 0 $ 3 1 , 9 8 0



5 $ 5 3 , 2 4 3 $ 3 7 , 4 1 4



6 $ 6 0 , 9 7 6 $ 4 2 , 8 4 8


SNAP (Cupones para alimentos) Medicaid 7 $ 6 8 , 7 0 9 $ 4 8 , 2 8 2



8 + $ 7 6 , 4 4 2 $ 5 3 , 7 1 6



Circunstancias financif i r a s L o s t i t u l a r e s q u e p r e s e r i t e n p r o g r a m a s p a r a l a s c u a l e s a u t o r i d a d p a r a r e d u c i r d e m o s t r a r s u s m o t i v o s

e s c e n a r i o s q u e a f e c t e n s u c a p a c i d a d p a r a p a g a r l a s t a r i f a s d e l o s c a l i f i q u e n p o d r a n d i s c u t i r s u s i t u a c i o n c o n e l D i r e c t o r , q u i e n t i e n e l a

l a s t a r i f a s . Es p r o b a b l e q u e s e r e q u i e r a d o c u m e n t a c i o n a d i c i o n a l p a r a

Aprobacion del directcir: El d i r e c t o r d e l i W a l k t h e E n o r e v i s a r a c a d a u n a d e l a s s o l i c i t u d e s d e r e d u c c i o n y t e n d r a l a a u t o r i d a d f i n a l p a r a a p r o b a r o r e ^ h a z a r u n a s o l i c i t u d . C u a l q u i e r p r e g u n t a c o n r e s p e c t o a e s t a p o l i t i c a d e b e s e r d i r i g i d a a l p e r s o n a l d e l E n o R i v e r A s s o c i a t i o n a l ( 9 1 9 ) 6 2 0 - 9 0 9 9 x 2 0 4 o e n o f i e l d s t a t i o n @ e n o r i v e r . o r g .

Nombres de Miembn >s del hogar Cantidad max. que recibe de miembros del hogar 1 $ 2 $ 3 $ 4 $ 5 $

Ingreso annual total del hogar: Firma de la cabeza de| hoear. Fecha_

Vuelve con Camp Solicttud to: Eno River Association, 4404 Guess Rd., Durham, NC 27712

WAIVER ANp REUEAgE QF 1-IABILITY FROG HOLLOW

Participant's Name (Please Print)

Address

I M P O R T A N T . R E A D C j I ^ R E F U L L Y whether you are an adi(lt by Frog Hollow L L C . It guardian agrees to may sign for a minor

these

In consideration of the by Provider, Participant and agree as follows:

[PART II] Activities. Hazards and Risks Provider The services of the

kayak (referred to, collectively may include, in addition portaging (carrying the

strike or be struck by activities include those

. This document affects your legal rights. It must be signed by you, the Participant., or minor, if you are renting or otherwise using equipment or participating in activities offered

must be signed also by your parent or guardian if you are a minor Participant. The parent or terms individually and on behalf of the minor. Only a parent or legally appointed guardian

Participant. References to .1. or .we. include all who sign below unless otherwise clearly indicated.

P A R T I C I P A N T A G R E E M E N T (Including Acknowledgement and Assumption of Risks ,

Agreements of release and Indemnity, and Additional Provisions)

opportunity to rent or otherwise use certain equipment and /or participate in activities offered (adult or minor), and the parent or guardian of a minor Participant, understand, acknowledge

may include renting equipment and providing trips (including guided trips) by canoe or as watercraft). Activities, scheduled and unscheduled, associated with these services

to travel by water, swimming, wading, hiking, climbing on rocks and slopes, camping, watercraft between water travel sites) and travel to and from the activities.

The hazards and risks (together referred to as risks.) of the use of watercraft include the following: entering, exiting, and operating watercrsft; water which may be fast, deep, cold, and subject to rapid change; objects which may be encountered in and out of the water, and which may not be obvious, including debris, trees, rocks, boulders, dams, bridges, and other hazsirds; the watercraft may overturn, swamp and sink and occupants may become separated from the craft; feet and othei parts of the body may become entrapped in or under rocks and other objects; participants may

objects, other watercraft, and other persons, in and outside of the watercraft. Risks of other : associated with camping, hiking and moving on and over terrain, including the shoreline, the

premises of Provider ailid others, and elsewhere, which may be unstable, steep and slippery and where rocks, trees, and other objects may fall, and man-made and natural structures may fail; animals, including poisonous reptiles, poisonous insects, and poisonous plants may cause harm; swimming in unfamiliar surroundings may cause entrapment, injury froi n slips and falls amd drowning. Other r isks include errors in judgment of Provider's staff and other participants, including the improper assessment of capabilities and conditions pertaining to the activities; certain activities may be instructional, and designed to extend the skills of participants; equipment may be misused or may fail because of manufacturing defects or otherwise; collisions may occur while traveling by vehicle to and from the activities; the activities are subject to the unpredictable forces of nature, including exposure to the sun , cold, wind, hail , lightning, flash qoods and other s u c h phenomena; activities may take place in remote places, significantly delaying emergency me Jical care and evacuation.

Participant, and the activities and risks include risks which Participation in the due to contaminated and serious injury and

p rent or guardian of a minor participant, acknowledge and understand that the description of is not complete and that all activities, whether or not described, may be dangerous and may inherent and cannot be reasonably avoided without changing the nature of the activity.

can cause bites, stings, allergic reactions, overexertion, heat stroke, hsrpothermia, illness , b u m s , cuts, bruises, strains, broken bones, and other injuries and illnesses. Property loss,

death, including by falling and drowning, are possible.

abo/e

act vities Wiiter

Client, and the parent medical, physical or otlier water conditions, routes, may, impair judgment land activities; participant; over them; participants footwear which will provide to adhere to these and

I , the Participant (adul^ services of R-ovider an r isks of the activities.

or guardian of a minor Participant, accepts full responsibility for determining Participant's qualifications or suitability for participating in the activities. Provider is not responsible for

, camp sites, or other activities of renters of its equipment. Alcohol will,, and other substances and reduce a participant's ability to effectively manage the risks of water travel, camping, and

s should inspect unfamiliar rapids and other hazards before attempting to pass through or should always wear a fastened life jacket (personal flotation device); participants should wear

protection from sharp objects, and which will minimize the risk of foot entrapment. Failure other safety precautions may result in serious injury or death.

[PART III] Acknowledge! gent and Assumption of Risks or minor) and the parent or guardian of a minor Participant, understand the nature of the

1 other activities, which may occur, and their r isks . I acknowledge and expressly assume all whether or not described above, known or unknown, and inherent or otherwise. I tcike full

responsibility for any irljUry whole or part out of s u c h

[PART IV] Ag-eement of If I a m a n adult participant minor Participant for wl|om

Release and Indemnification, and Additional Provisions

I release Provider, its claims of injury or loss my, or the child's, enroll minor child, nor anyon Party.

employees, contractors, volunteers, directors and owners (.Released Parties.) from any and all which I , or the minor child for whom I sign, may suffer, arising out of or in any way related to ment in or participation in the activities of Provider or the use of its equipment. Neither I , the acting on our behalf, will bring suit or otherwise assert any such claims against a Released

I will indemnify (that is Released Party from an; in any of the activities c loss arising out of or in or the use of its equipmtent.

defend and satisfy by pajmient or reimbursement, including costs and attorneys, fees) each T claim of liability, including one brought by or for a minor child whom I sign, a co-participant f Provider, a rescuer, a member of my, or the minor child's, family, or any one else, asserting a any way related to my, or the child's, enrollment in or participation in the activities of Provider

H i e agreements of this not grossly negligent, other claims, includinj; liability), breach of allowed by law, and to individually and on behalf

elease and indemnification above include claims arising in whole or in part from negligent (but reckless or intentionally wrong) acts or omissions of Released Parties or any of them, and all

for personal injury, wrongful death, property damage, products liability (including strict or warranty, or otherwise. The agreements are intended to be enforced to the fullest extent

be binding on me as Participant and on me as parent or guardian of a minor Participant, of the minor for whom I sign.

F contract

[PART V] Additional Pro visions I authorize Provider to necessary and appropr dispute between Provider State of North Carolina suit shall take place agreement, I agree to sdbmit and attorneys fees incutred whom I sign, if the responsible for the claitiied

ente red [PART VI] T h i s agreement is writing. I understand respective heirs, members. If any part of of the agreement

executors

nevert leless

S I G N A T U R E : Participant (adult or minor)

D a t e : .

S IGNATURE: Parent or

or loss, including death, which I , or a minor child for whom I sign, may suffer, arising in activities.

or the parent or guardian of a minor Participant, I agree, for myself and on behalf of the I am signing, as follows:

])rovide or obtain for me, or the minor child for whom I sign, s u c h medical care as it considers ate, and 1 agree to pay all costs associated with such care and related transportation. Any

and me or the minor child for whom 1 sign will be governed by the substantive laws of the not including laws which might apply the laws of another jurisdiction), and any mediation or

in that State, in the County of Durham. If the dispute cannot be resolved by mutual it to a mediator recognized by the Courts of that State and County. 1 agree to pay all costs

by Provider in defending a claim or suit brought by me or by or on behalf of the minor for or suit is withdrawn or to the extent a court or mediator determines that Provider is not injury or loss.

only

into voluntarily, and after careful consideration. Its terms cannot be amended except in that it is binding, to the fullest extent allowed by law, upon all persons signing below, our

administrators, wards, minor children (whether or not they are Clients) and other family this agreement is found by a Court or other appropriate authority to be invalid, the remainder

shal l be in full force and effect.

j u a r d i a n

Date:

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