Parent Information Packet - School Year Camp

Everything is subject to change based on any changes within HCPS and MSDE. You will be updated immediately of these changes.

With HCPS being set to remain virtual for the fall and winter of 2020 we want to offer a full day care option for parents for these months.

We will provide a safe, fun, environment for your children to complete virtual independent learning along with exercise and gross motor activities throughout the day. Camp will run from September

8th until the end of the year. We will offer Jan dates after re evaluating in late fall.

Daily Schedule

Daily Schedule will be based on schedule for HCPS virtual/independent learning.

Times

Monday through Friday 8-5p

Days offered

5-day camp only. Part time schedules may be available on a limited basis. Families interested will need to contact camp director

directly.

Drop off/ Pick up

Drop off and pick up will be located outside our building located near our side parking lot. We will be located under the green stairs

every day. Please make sure you are maintaining distance between

families at drop off and pick up. Parents and children must wear masks during drop off and pick up.

Temperature Check

Each morning at drop off you will need to take your child’s temperature. This will be done at the time of drop off by each

parent. Please bring your own thermometer daily to check your child’s temperature in front of staff. If your child’s temp exceeds

100.4, they will not be allowed to stay at camp that day. You will also be asked a set of 3 questions about their health and exposure to

COVID-19. Please read over these questions and know you may only drop off your child if you are answering no to all three of them. Please know these are guidelines we are following that have been

given to us by the state.

Groups

Each group at this time will have 14 children and 1 staff member.

Classrooms

Each group will be in one designated classroom each day. They will utilize these classrooms for virtual independent learning, lunch and some free play time. We will also utilize our indoor basketball area

and outside playground area in the afternoons for exercise and gross motor activities.

Staff

We guarantee that our camp staff is like none other in the area. Our entire team is fingerprinted, background checked, and First Aid and

CPR certified. All of our staff have years of instructional experience with children.

Ages

Kindergarten through 8th grade.

Cost

5-day camp only

219.00 weekly member rate

259.00 weekly nonmember rate

10% Sibling Discount for multiple children

One-time $25.00 nonrefundable registration fee per family

Child must be a current member in order to receive member price.

Payments

All registrations are Pay in Full. All registrations done pay as you go need to be submitted the Friday prior. Spots not guaranteed

available due to limited spots. No refunds given for any partial, unused, unattended or canceled weeks.

Masks and Safe Distance Practices Any child attending camp that is 5 years and older must bring a

mask with them. Children are required to wear masks indoors when it is safe for them to do so. Children will be required to wear a mask

outdoors if they are not safely six feet apart. We will at all times reminding children to stay a safe distance between themselves and

other students. We will follow all guidelines given to us by MDH and MSDE.

Chrome Books

Per HCPS Each child will be given a Chrome Book or other alternative so they can access virtual learning daily. In order for your

child to attend they will need to come with a Chrome Book or another form to access virtual learning daily.

Closings

We will be closed on the following days:

Thanksgiving Day

Black Friday

Christmas Eve

Christmas Day

New Year’s Eve

New Year’s Day

Prices for these particular weeks will reflect days off.

Safety

Keeping your child safe is our number one priority. Please make sure any one dropping and picking up your child has an ID on them so

our staff can check daily. All authorized persons able to pick up your child should be written on the emergency card in paperwork

packet. If a person is not listed, they will not be permitted to pick up your child. Any changes needed to be made to pick must be

discussed with Camp Director. All areas used by camp will be safely locked and will be used only by camp children.

Health

New health screenings have been put in place to follow MDH and MSDE guidelines. Any child with a temperature above 100.4 will not be permitted to camp that day. Please see COVID-19 graph below that we will follow per guidelines given to us by the MDH and MSDE.

Paperwork

There is a packet of paperwork that will need to be filled out for each child prior to them starting camp. There are forms in that

packet that will need to be filled out by the child’s doctor. It is very important these are filled out fully and correctly. All paperwork must

be submitted to camp director prior to the first day of camp. Children will not be permitted to camp without proper paperwork. If

your child requires medicine during the day of camp there will be additional paperwork needed to be filled out. Please contact camp

director for those papers.

If you have any questions or concerns please contact camp director Amy Carr at 410-734-7300 ext 144 or acarr@thearenaclub.com

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CACFP Enrollment:Yes:___No:___ MARYLAND STATE DEPARTMENT OF EDUCATION – Office of Child Care Meals your child will receive while in care:

BK___ LN___SU___ AM Snk___ PM Snk___ Evng Snk___EMERGENCY FORM

INSTRUCTIONS TO PARENTS: (1) Complete all items on this side of the form. Sign and date where indicated. (2) If your child has a medical condition which might require emergency medical care, complete the back side of the form. If necessary, have your child’s

health practitioner review that information.

NOTE: THIS ENTIRE FORM MUST BE UPDATED ANNUALLY.

Child’s Name ___________________________________________________________________________ Birth Date ___________________________ Last First

Enrollment Date ______________________________ Hours & Days of Expected Attendance ____________________________________

Child’s Home Address __________________________________________________________________________________________________________ Street/Apt. # City State Zip Code

Parent/Guardian Name(s) Relationship Phone Number(s)

Place of Employment:

___________________________

W:

C: H:

Place of Employment:

___________________________

W:

C: H:

Name of Person Authorized to Pick up Child (daily) ___________________________________________________________________________________ Last First Relationship to Child

Address _____________________________________________________________________________________________________________________ Street/Apt. # City State Zip Code

Any Changes/Additional Information_____________________________________________________________________________________________

ANNUAL UPDATES _____________________ ______________________ ______________________ ______________________ (Initials/Date) (Initials/Date) (Initials/Date) (Initials/Date)

When parents/guardians cannot be reached, list at least one person who may be contacted to pick up the child in an emergency:

1. Name _____________________________________________________________ Telephone (H) _________________ (W) __________________ Last First

Address _________________________________________________________________________________________________________________ Street/Apt. # City State Zip Code

2. Name ______________________________________________________________ Telephone (H) _________________ (W) __________________Last First

Address _________________________________________________________________________________________________________________ Street/Apt. # City State Zip Code

3. Name ______________________________________________________________ Telephone (H) _________________ (W) __________________Last First

Address _________________________________________________________________________________________________________________ Street/Apt. # City State Zip Code

Child’s Physician or Source of Health Care ___________________________________________________ Telephone ____________________________

Address _____________________________________________________________________________________________________________________ Street/Apt. # City State Zip Code

In EMERGENCIES requiring immediate medical attention, your child will be taken to the NEAREST HOSPITAL EMERGENCY ROOM. Your signature authorizes the responsible person at the child care facility to have your child transported to that hospital.

Signature of Parent/Guardian ____________________________________________________________Date ___________________________________

OCC 1214 (Revised 6/2020) - Side 1 of 2 - All previous editions are obsolete.

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INSTRUCTIONS TO PARENT/GUARDIAN: (1) Complete the following items, as appropriate, if your child has a condition(s) which might require emergency medical

care. (2) If necessary, have your child’s health practitioner review the information you provide below and sign and date where

indicated.

Child’s Name: ___________________________________________________ Date of Birth: _______________________

Medical Condition(s): _________________________________________________________________________________

Medications currently being taken by your child: ____________________________________________________________

Date of your child’s last tetanus shot: _____________________________________________________________________

Allergies/Reactions: ___________________________________________________________________________________

EMERGENCY MEDICAL INSTRUCTIONS: (1) Signs/symptoms to look for: _________________________________________________________________________

(2) If signs/symptoms appear, do this: _____________________________________________________________________

(3) To prevent incidents: _______________________________________________________________________________

OTHER SPECIAL MEDICAL PROCEDURES THAT MAY BE NEEDED: __________________________________________

COMMENTS: ________________________________________________________________________________________

Note to Health Practitioner:

If you have reviewed the above information, please complete the following:

Name of Health Practitioner Date

_________________________________________________ (_____)______________________________ Signature of Health Practitioner Telephone Number

OCC 1214 (Revised 6/2020) - Side 2 of 2 - All previous editions are obsolete.

MARYLAND STATE DEPARTMENT OF EDUCATION Office of Child Care

HEALTH INVENTORY Information and Instructions for Parents/Guardians

REQUIRED INFORMATION

The following information is required prior to a child attending a Maryland State Department of Education licensed, registered or approved child care or nursery school:

• A physical examination by a physician or certified nurse practitioner completed no more than twelve months prior toattending child care. A Physical Examination form designated by the Maryland State Department of Education and theDepartment of Health and Mental Hygiene shall be used to meet this requirement (See COMAR 13A.15.03.02, 13A.16.03.02and 13A.17.03.02).

Evidence of immunizations. A Maryland Immunization Certification form for newly enrolling children may be obtained from thelocal health department or from school personnel. The immunization certification form (DHMH 896) or a printed or a computergenerated immunization record form and the required immunizations must be completed before a child may attend. This formcan be found at:http://earlychildhood.marylandpublicschools.org/system/files/filedepot/3/maryland_immunization_certification_form_dhmh_896_-_february_2014.pdf

Evidence of Blood-Lead Testing for children living in designated at risk areas. The blood-lead testing certificate (DHMH 4620) (or another written document signed by a Health Care Practitioner) shall be used to meet this requirement. This form can be found at: http://earlychildhood.marylandpublicschools.org/system/files/filedepot/3/dhmh_4620_bloodleadtestingcertificate_2016.pdf

•

•

EXEMPTIONS

Exemptions from a physical examination, immunizations and Blood-Lead testing are permitted if the family has an objection based on their religious beliefs and practices. The Blood-Lead certificate must be signed by a Health Care Practitioner stating a questionnaire was done.

Children may also be exempted from immunization requirements if a physician, nurse practitioner or health department official certifies that there is a medical reason for the child not to receive a vaccine.

The health information on this form will be available only to those health and child care provider or child care personnel who have a legitimate care responsibility for your child.

INSTRUCTIONS

Please complete Part I of this Physical Examination form. Part II must be completed by a physician or nurse practitioner, or a copy of your child's physical examination must be attached to this form.

If your child requires medication to be administered during child care hours, you must have the physician complete a Medication Authorization Form (OCC 1216) for each medication. The Medication Authorization Form can be obtained at

http://earlychildhood.marylandpublicschools.org/system/files/filedepot/3/occ1216-medicationadministrationauthorization.pdf

If you do not have access to a physician or nurse practitioner or if your child requires an individualized health care plan, contact your local Health Department.

OCC 1215 - Revised June 2016 - All previous editions are obsolete Page 1 of 5

PART I - HEALTH ASSESSMENT To be completed by parent or guardian

e: Birth date: Sex

OCC 1215 - Revised June 2016 - All previous editions are obsolete. Page 2 of 5

Child’s Nam

Address:

Last First Middle Mo / Day / Yr M F

Number Street Apt# City State Zip Parent/Guardian Name(s) Relationship Phone Number(s)

W: C: H: W: C: H:

Your Child’s Routine Medical Care Provider Name: Address: Phone #

Your Child’s Routine Dental Care Provider Name: Address: Phone

Last Time Child Seen for Physical Exam: Dental Care: Any Specialist :

ASSESSMENT OF CHILD’S HEALTH - To the best of your knowledge has your child had any problem with the following? Check Yes or No and provide a comment for any YES answer.

Yes No Comments (required for any Yes answer) Allergies (Food, Insects, Drugs, Latex, etc.) Allergies (Seasonal) Asthma or Breathing Behavioral or Emotional Birth Defect(s) Bladder Bleeding Bowels Cerebral Palsy Coughing Communication Developmental Delay Diabetes Ears or Deafness Eyes or Vision Feeding Head Injury Heart Hospitalization (When, Where)

Lead Poison/Exposure complete DHMH4620 Life Threatening Allergic Reactions Limits on Physical Activity Meningitis Mobility-Assistive Devices if any Prematurity Seizures Sickle Cell Disease Speech/Language Surgery Other Does your child take medication (prescription or non-prescription) at any time? and/or for ongoing health condition?

No Yes, name(s) of medication(s):

Does your child receive any special treatments? (Nebulizer, EPI Pen, Insulin, Counseling etc.)

No Yes, type of treatment:

Does your child require any special procedures? (Urinary Catheterization, G-Tube feeding, Transfer, etc.)

No Yes, what procedure(s):

I GIVE MY PERMISSION FOR THE HEALTH PRACTITIONER TO COMPLETE PART II OF THIS FORM. I UNDERSTAND IT IS FOR CONFIDENTIAL USE IN MEETING MY CHILD’S HEALTH NEEDS IN CHILD CARE.

I ATTEST THAT INFORMATION PROVIDED ON THIS FORM IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE AND BELIEF.

Signature of Parent/Guardian Date

PART II - CHILD HEALTH ASSESSMENT To be completed ONLY by Physician/Nurse Practitioner

ere be any restriction of physical activity in child care?

has had a complete physical examination and any concerns have been noted above. (Child’s Name)

Additional Comments:

OCC 1215 - Revised June 2016 - All previous editions are obsolete. Page 3 of 5

Physician/Nurse Practitioner (Type or Print):

Phone Number:

Physician/Nurse Practitioner Signature:

Date:

Child’s Name:

Birth Date:

Sex Last First Middle Month / Day / Year M F

1. Does the child named above have a diagnosed medical condition?

No Yes, describe:

2. Does the child have a health condition which may require EMERGENCY ACTION while he/she is in child care? (e.g., seizure, allergy, asthma, bleeding problem, diabetes, heart problem, or other problem) If yes, please DESCRIBE and describe emergency action(s) on the emergency card.

No Yes, describe:

3. PE Findings Not

Health Area WNL ABNL Evaluated Not

Health Area WNL ABNL Evaluated Attention Deficit/Hyperactivity Lead Exposure/Elevated Lead Behavior/Adjustment Mobility Bowel/Bladder Musculoskeletal/orthopedic Cardiac/murmur Neurological Dental Nutrition Development Physical Illness/Impairment Endocrine Psychosocial ENT Respiratory GI Skin GU Speech/Language Hearing Vision Immunodeficiency Other: REMARKS: (Please explain any abnormal findings.)

4. RECORD OF IMMUNIZATIONS – DHMH 896/or other official immunization document (e.g. military immunization record of immunizations) is required to be completed by a health care provider or a computer generated immunization record must be provided. (This form may be obtained from: http://earlychildhood.marylandpublicschools.org/system/files/filedepot/3/maryland_immunization_certification_form_dhmh_896_-_february_2014.pdf

RELIGIOUS OBJECTION:

I am the parent/guardian of the child identified above. Because of my bona fide religious beliefs and practices, I object to any immunizations being given to my child. This exemption does not apply during an emergency or epidemic of disease.

Parent/Guardian Signature: Date:

5. Is the child on medication? No Yes, indicate medication and diagnosis:

(OCC 1216 Medication Authorization Form must be completed to administer medication in child care). 6. Should th

No

Yes, specify nature and duration of restriction:

7. Test/Measurement

Results

Date Taken Tuberculin Test Blood Pressure Height Weight BMI %tile

LeadTest Indicated:DHMH 4620 Yes No Test #1 Test#2 Test # 1 Test #2

/ / / STREET ADDRESS (with Apartment Number) CITY STATE ZIP

Page 4 of 5 OCC 1215 -June 2106

MARYLAND DEPARTMENT OF HEALTH AND MENTAL HYGIENE BLOOD LEAD TESTING CERTIFICATE

Instructions: Use this form when enrolling a child in child care, pre-kindergarten, kindergarten or first grade. BOX A is to be completed by the parent or guardian. BOX B, also completed by parent/guardian, is for a child born before January 1, 2015 who does not need a lead test (children must meet all conditions in Box B). BOX C should be completed by the health care provider for any child born on or after January 1, 2015, and any child born before January 1, 2015 who does not meet all the conditions in Box B. BOX D is for children who are not tested due to religious objection (must be completed by health care provider).

BOX A-Parent/Guardian Completes for Child Enrolling in Child Care, Pre-Kindergarten, Kindergarten, or First Grade

CHILD'S NAME / / LAST FIRST MIDDLE

CHILD’S ADDRESS / / / STREET ADDRESS (with Apartment Number) CITY STATE ZIP

SEX: Male Female BIRTHDATE / / PHONE

PARENT OR / / GUARDIAN LAST FIRST MIDDLE

BOX B – For a Child Who Does Not Need a Lead Test (Complete and sign if child is NOT enrolled in Medicaid AND the answer to EVERY question below is NO):

Was this child born on or after January 1, 2015? YES NO Has this child ever lived in one of the areas listed on the back of this form? YES NO Does this child have any known risks for lead exposure (see questions on reverse of form, and

talk with your child’s health care provider if you are unsure)? YES NO

If all answers are NO, sign below and return this form to the child care provider or school.

Parent or Guardian Name (Print): Signature: Date:

If the answer to ANY of these questions is YES, OR if the child is enrolled in Medicaid, do not sign Box B. Instead, have health care provider complete Box C or Box D.

BOX C – Documentation and Certification of Lead Test Results by Health Care Provider Test Date Type (V=venous, C=capillary) Result (mcg/dL) Comments Comments:

Person completing form: Health Care Provider/Designee OR School Health Professional/Designee

Provider Name: Signature:

Date: Phone:

Office Address:

BOX D – Bona Fide Religious Beliefs

I am the parent/guardian of the child identified in Box A, above. Because of my bona fide religious beliefs and practices, I object to any blood lead testing of my child. Parent or Guardian Name (Print): Signature: Date: ******************************************************************************************************************** This part of BOX D must be completed by child’s health care provider: Lead risk poisoning risk assessment questionnaire done: YES NO

Provider Name: Signature:

Date: Phone:

Office Address:

DHMH FORM 4620 REVISED 5/2016 REPLACES ALL PREVIOUS VERSIONS

Page 5 of 5 OCC 1215-June2016

HOW TO USE THIS FORM

The documented tests should be the blood lead tests at 12 months and 24 months of age. Two test dates and results are required if the first test was done prior to 24 months of age. If the first test is done after 24 months of age, one test date with result is required. The child’s primary health care provider may record the test dates and results directly on this form and certify them by signing or stamping the signature section. A school health professional or designee may transcribe onto this form and certify test dates from any other record that has the authentication of a medical provider, health department, or school. All forms are kept on file with the child’s school health record.

At Risk Areas by ZIP Code from the 2004 Targeting Plan (for children born BEFORE January 1, 2015)

Baltimore Co. Frederick Prince George’s Queen Anne’s Allegany (Continued) Carroll (Continued) Kent (Continued) (Continued)

ALL 21212 21155 21776 21610 20737 21640 21215 21757 21778 21620 20738 21644

Anne Arundel 21219 21776 21780 21645 20740 21649 20711 21220 21787 21783 21650 20741 21651 20714 21221 21791 21787 21651 20742 21657 20764 21222 21791 21661 20743 21668 20779 21224 Cecil 21798 21667 20746 21670 21060 21227 21913 20748 21061 21228 Garrett Montgomery 20752 Somerset 21225 21229 Charles ALL 20783 20770 ALL 21226 21234 20640 20787 20781 21402 21236 20658 Harford 20812 20782 St. Mary’s

21237 20662 21001 20815 20783 20606 Baltimore Co. 21239 21010 20816 20784 20626

21027 21244 Dorchester 21034 20818 20785 20628 21052 21250 ALL 21040 20838 20787 20674 21071 21251 21078 20842 20788 20687 21082 21282 Frederick 21082 20868 20790 21085 21286 20842 21085 20877 20791 Talbot 21093 21701 21130 20901 20792 21612 21111 Baltimore City 21703 21111 20910 20799 21654 21133 ALL 21704 21160 20912 20912 21657 21155 21716 21161 20913 20913 21665 21161 Calvert 21718 21671 21204 20615 21719 Howard Prince George’s Queen Anne’s 21673 21206 20714 21727 20763 20703 21607 21676 21207 21757 20710 21617 21208 Caroline 21758 20712 21620 Washington 21209 ALL 21762 20722 21623 ALL 21210 21769 20731 21628

Wicomico ALL

Worcester

ALL

Lead Risk Assessment Questionnaire Screening Questions:

1. Lives in or regularly visits a house/building built before 1978 with peeling or chipping paint, recent/ongoing renovation or remodeling?

2. Ever lived outside the United States or recently arrived from a foreign country? 3. Sibling, housemate/playmate being followed or treated for lead poisoning? 4. If born before 1/1/2015, lives in a 2004 “at risk” zip code? 5. Frequently puts things in his/her mouth such as toys, jewelry, or keys, eats non-food items (pica)? 6. Contact with an adult whose job or hobby involves exposure to lead? 7. Lives near an active lead smelter, battery recycling plant, other lead-related industry, or road where soil and dust may be

contaminated with lead? 8. Uses products from other countries such as health remedies, spices, or food, or store or serve food in leaded crystal, pottery or

pewter.

DHMH FORM 4620 REVISED 5/2016 REPLACES ALL PREVIOUS VERSIONS

The Arena Club Discipline Policy

The goal of our r Camp is to provide a fun and safe environment for your child to do independent learning, play and have an incredible day. Periodically, discipline problems arise and must be addressed. Unfortunately, some problems escalate to a level that requires discipline or even expulsion. The following outlines are our policies and courses of action. We employ a “three strikes” discipline policy

Strike 1

• If a staff member identifies an incident or consistent behavioral problem, the incidentwill be brought to the camp director.

• The first offense will result in a consultation with the camp director. The director willinform a parent at pick-up or by telephone if need be.

• A first strike may result in quiet time or an elimination of certain camp privileges oractivities for that particular day.

Strike 2

• If an additional; incident or persistent poor behavior continues, the incidents will bebrought to the camp director’s attention.

• The second offense will result in a consultation with the camp director. A writtenincident report will be taken and noted in the child’s file and the situation will bediscussed with a parent or guardian.

• A second strike will result in quiet time and/or elimination of certain camp privileges oractivities for the day or week if need be.

Strike 3

• In the event that an additional incident or poor behavior continues, the camp directorwill be notified and then a parent will be called immediately.

• The third offense can result in expulsion from camp.• In event of an expulsion, there will be no refund of monies.

The following are examples of behavior that are considered poor and justify disciplinary action. This does not include all possible offenses. The camp management will use their best judgment in determining offenses.

• Consistently ignoring counselor directions or instructions.• Outbursts or excessive anger.• Improper pool behavior• Deliberate tripping, shoving, or aggressive behavior during an activity• Any unsafe behavior to self or other children• Constant arguing with counselors or other children• Foul or abusive language• Pushing, shoving, or spitting• Fighting- (depending on the severity of the situation, fighting can lead directly to immediate

expulsion from the program)If a camper behaves in a way management feels is completely unacceptable to the camp guidelines, The Arena Club reserves the right to expel a camper immediately without utilizing the strike policy.

RELEASE OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT

In consideration of the services provided by Harford Health and Fitness Club, Inc (d/b/a: The Arena Club) (“the Club”) and of the permission granted by the Club to use the Club’s property, facilities, and services and to participate in trampoline court activities and other amusement activities at the Club (“the Activities”), I, on behalf of myself and on behalf of my child or children and any other minors within my care as listed below (“Minors”), agree to the following terms and conditions. I understand that this document affects my legal rights and the legal rights of the Minors, and that by signing below I acknowledge that I have read and understood the disclosure of risks, voluntarily accept those risks, and agree to be bound by all terms and conditions of this agreement.

1. General Release and Waiver of Liability. In consideration of the services provided by the Cluband of the permission granted by the Club to use the Club’s property, facilities, and services andto participate in the Activities, I, for myself and on behalf of my spouse, children, wards, heirs,assigns, personal representatives and next of kin (the “Releasing Parties”), voluntarily release andforever discharge and agree not to sue the Club and its agents, members, managers, owners,officers, directors, principals, volunteers, participants, insurers, facility operators, lessors,successors, assigns, equipment suppliers and manufacturers, trainers, intellectual propertyholders, and any and all other persons or entities acting in any capacity on the Club’s behalf(hereinafter collectively referred to as the “Protected Parties”) from liability for any claimsconnected with or arising from my or the Minors’ participation in the Activities or use of the Clubfacilities, including, to the extent allowed by law, any such claims which allege negligent acts oromissions of any of the Protected Parties.

I understand that this release of liability will prevent any of the Releasing Parties, including meand the Minors, from bringing any lawsuit or making any claim for personal injury, damages ordeath connected with participating in the Activities or using the Club facilities.

2. Acknowledgement of Risks. I understand that my participation and the participation of theMinors in the Activities involves known and unanticipated risks that could result in physical oremotional injury, paralysis, death, or damage to me, to the Minors, or to third parties. Such risks(the “Risks”) include:• the risks inherent in the Activities, including but not limited to slipping and falling, collisions

with fixed objects and/or other participants, falling off equipment, unexpected failure ofequipment, over-exertion, double bouncing, failed attempted jumps and stunts, and sustaininglacerations or contracting any illnesses from contact with equipment and/or flooring surfacesin the Club;

• the negligent acts or omissions of the Protected Parties, or their agents or employees;• defects in the Club facilities;• improper or inadequate instruction or supervision regarding the Activities or use of the Club

facilities;• the behavior of other participants in the Activities;• accidents or incidents in the Club facilities; and

• first aid, emergency treatment or services rendered or failed to be rendered by the ProtectedParties or their agents or employees.

Possible injuries include, but are not limited to, bruises, sprains, scrapes, contusions, lacerations, broken bones, eye injuries, torn ligaments, joint injuries, weakening of growth plates, stunted growth following fractures, internal injuries, brain injuries and concussions, permanent disabilities, broken back, broken neck, paralysis, heart attack or death.

I understand and acknowledge that the above lists are not complete or exhaustive, and that other known or unanticipated risks may also result in injury, death, illness or damage to me, to the Minors or to our property.

3. Assumption of Risks. After being fully informed of the above risks, I, on my own behalf and, tothe fullest extent allowed by law, on behalf of all Releasing Parties and the Minors, expresslyagree and promise to accept and assume all known and unanticipated risks associated withparticipation in the Activities and use of the Club’s facilities, including the Risks listed above,and I voluntarily elect to participate and to allow the Minors to participate in the Activities anduse the Club’s facilities.

I agree that there are certain risks inherent in the Activities that cannot be avoided or eliminated,and that by signing this form I am giving up my right and the right of the Minors to recover fromthe Protected Parties in a lawsuit or other proceedings or any damages, including personal injuryor death to me or the Minors, that results from such risks. I understand that I have the right torefuse to sign this form, and the Club has the right to refuse to let me or the Minors participate if Ido not sign this form.

4. Indemnification Agreement. (a) I hereby agree to hold harmless, indemnify and defend theProtected Parties from and against any and all claims, losses, actions, proceedings, costs,expenses, damages, settlement amounts and liabilities (including claims brought by any of theReleasing Parties or Minors) and any and all costs and expenses in connection therewith,including attorneys’ fees and costs of investigation (collectively the “Claims”), arising out of orconnected with my or the Minors’ participation in the Activities or use of the Club’s facilities,regardless of whether the Claims are the result of the negligent acts or omissions of myself, theMinors, the Protected Parties, or third parties, including other participants in the Activities. Suchindemnity obligation shall include, but not be limited to, any claim, action or proceeding thatalleges that I or the Minors negligently or intentionally caused any injury, death or damage toother participants in the Activities or other third parties at the Club.

(b) In the event of any claim, action or proceeding is brought against the Club or its agents,members, managers, owners, officers, directors or principals that falls within the scope of Section4(a), I agree to pay $50,000 to the Club as an advance deposit to be used for payment of costs andexpenses incurred by settlement amounts and damages, with such amount to be paid to the Clubwithin fifteen (15) days of receiving written notice from the Club of such claim, action orproceeding. If during the pendency of the claim, action or proceeding the advance deposit isdrawn upon and falls below $15,000, upon receiving notice from the Club I agree to replenish thedeposit amount to $50,000 within fifteen (15) days of receiving such notice. I understand that atthe conclusion of the claim, action or proceeding, including the resolution of any appeals, theClub will refund to me any remaining portion of such deposit not used to reimburse the Club forcosts and expenses incurred in connection with such claim, action or proceeding. The Club byaccepting such deposit does not waive its rights under this agreement to collect any additionalamounts owed pursuant to this agreement.

5. Release of Rights to Audio, Video and Photographic Images. I hereby grant the Club on behalfof myself and the Minors the irrevocable right and permission to photograph and/or record me orthe Minors in connection with the Activities and the Club and to use the resulting photographicimages, audio or video for all purposes, including advertising and promotional purposes, in anymatter and in any media now or hereafter known, in perpetuity throughout the world, withoutrestriction as to alteration, and without any reimbursement of any kind due to me or the Minors.On my behalf and on behalf of the Minors, I waive any right to inspect or approve the use of anysuch photographic image, audio or video. I agree that the Club will be the exclusive owner of allrights, including but not limited to the copyrights, in and to the photographic images, audio andvideo and the results and proceeds of my participation hereunder.

6. Certifications. In order to assist the Club in effectively providing for the safety of me and theMinors, I certify that:

• I have no knowledge of any health problems that would cause participation in the Activities tonegatively impact my health of the health of the Minors

• I and the Minors possess a sufficient level of physical fitness and skill to safely participate in theActivities, and neither I nor the Minors have any pre-existing physical or medical conditions thatmight be impacted or worsened by use of the Club, including pregnancy, orthopedic problems,including back problems, heart problems, or breathing problems

• I will not use or allow the Minors to use the Club while any of us are under the use of any drugs.alcohol or medications that may impair our physical activities or judgment

• I agree to follow (and cause the Minors to follow) all safety rules of the Club and to alert the Clubstaff to any rules violations or dangerous behavior of other participants

• I understand that my failure or refusal to abide by the safety rules of the Club or by instructionsand directions of Club staff can lead to the immediate revocation of my right to use the Club,without any right to refund of any payments made

• I will notify Club staff before I or the Minors participate in Activities if any of us have beendiagnosed with behavior disorders or are taking any behavior modification medications

• I will inform Club staff immediately if I or the Minors feel any unusual discomfort whileparticipating in the Activities and will immediately stop (or cause the Minors to stop)participation in the Activities

• I am aware that Club staff may need to end my or the Minors’ participation in the Activities if myor the Minors’ actions present a danger to myself or others

• I authorize the Club staff to administer emergency first aid and CPR to myself and to the Minorswhen deemed necessary by Club staff

• I authorize the Club staff to secure emergency medical care or transportation if deemed necessaryby Club staff, and I agree to assume all costs of emergency medical care of transportation.

• I acknowledge that the Club encourages each participant to obtain medical clearance prior toparticipating in the Activities

• I have adequate insurance to cover any injury or damage I and the Minors may cause or sufferwhile participating in the Activities, or if not, I agree to bear the costs of such injury or damage tomyself, the Minors and others

7. Term of Agreement. I understand that this agreement shall continue in effect and will be in fullforce and legal effect each and every time I or the Minors visit the Club, whether at the currentlocation or any other location or facility. I agree that the Club may require me to sign a newagreement at any time as a requirement for my participation or the participation of the Minors inthe Activities.

8. Attorney’s Fees. I promise to indemnify the Club for any attorney’s fees and costs incurred by

the Club to enforce this agreement including costs associated with any collection efforts. If Club obtains a judgment against my pursuant to this agreement, prejudgment and post-judgment interest shall accrue thereon at the maximum amount allowed by applicable law.

9. Governing Law; Venue; Dispute Resolution. This agreement shall be governed by and interpreted in accordance with the laws of the state in which the Club is located (“Maryland”) without regard to the conflict of law rules Maryland. I agree and acknowledge that any claim or dispute arising or related to this agreement or the relationship of the parties in any respect thereto shall first be submitted to mediation, and that engaging in such mediation is a condition precedent to bringing any claim against the Club arising from or related to this agreement. Such mediation may be initiated by either party by providing a written demand for mediation to the other party and shall be conducted within Maryland in accordance with the then current Commercial Mediation Procedures of the American Arbitration Association (“AAA”). If settlement is not reached within sixty (60) days after delivery of a written demand for mediation, such claim or dispute shall be submitted to and be settled by final and binding arbitration in Maryland in accordance with the then current Commercial Arbitration Rules of the American Arbitration Association. If arbitration is not available, or in the event of litigation to enforce arbitration or settlement between the parties to this agreement, I agree that sole jurisdiction and venue shall be in the state and federal courts located in Maryland, and I waive any defense of jurisdiction and/or venue that may now or hereafter exist.

10. Entire Agreement; Severability. I understand that this is the entire agreement between the undersigned and the Club, and that it cannot be modified or changed in any way by the representations or statements of the Club or its employees or agents or by the undersigned. This agreement supersedes any and all previous oral or written promises or agreements.

I understand and agree that this agreement is intended to be as broad and inclusive as permitted by the laws of Maryland and that if any portion thereof is held invalid, it is agreed that the remainder of the agreement will remain in effect and will continue in full legal force and effect.

11. Effect of Agreement. I have read the above and fully understand the terms of this agreement and I have either consulted an attorney regarding the agreement or have elected not to do so. I am aware that by signing this agreement, I am giving up rights that I may have to be bring a legal action or assert a claim against the Protected Parties on the basis of their negligent acts or omissions. I understand that by signing this agreement I may be found by a court of law to have forever waived my rights and the rights of the Releasing Parties and the Minors to maintain any action against the Protected Parties on the basis of any claim from which I have released the Protected Parties. I am giving up these important legal rights voluntarily, freely, under no threat of duress, without inducement, promise or guarantee being communicated to me. I have had reasonable and sufficient opportunity to read and understand this entire agreement. I unconditionally agree to the full terms, statements, warranties, notices, representations, waivers and releases contained in this agreement on behalf of myself, the Releasing Parties and the Minors listed below.

I certify that I am the parent, legal guardian or authorized agent of the Minors listed below and that I have the authority to sign this agreement on their behalf. I also certify that the information provided below for each Minor participant is true and correct. I acknowledge that the Club staff may require me to present picture I.D. to verify my identity.

___________________________ ___________________________ ________ _________

Printed Name: Signature: Date D.O.B.

________________________________________________________ ____________________

Address: Phone:

___________________________ ___________________________

Emergency Contact: Phone:

Participants Under 18 Years of Age:

___________________________ ________ ___________________________

Name: Age: Relationship to Adult Participant:

___________________________ ________ ___________________________

Name: Age: Relationship to Adult Participant:

___________________________ ________ ___________________________

Name: Age: Relationship to Adult Participant:

___________________________ ________ ___________________________

Name: Age: Relationship to Adult Participant:

Waiver accepted by

Parent Signature: _____________________________________________Date: __________

Club Representative

Witness Signature: _____________________________________________Date: __________

Camp Pledge

I,__________________________, pledge to be a good Arena Club camp family member by:

• Keeping my child home if they have had a fever of higher than 100 degrees within the last threedays.

• Keeping my child home if they, or any roommate/family member, have displayed any symptoms ofillness.

• Keeping my child home for a minimum of 12 days after international and domestic hotspot travel.

• Disinfecting, washing hands, upon dropping child off.

• Respecting members’ and employees’ safety by adhering to social distancing of a minimum 6ft ormore during drop off and pick up.

• Respecting the allotted time to accommodate all new restrictions and guidelines given to us by thestate.

• When dropping off my child daily, being able to answer no to the following questions given tome by the camp director:

• Question 1: Have you developed any of the following symptoms of COVID-19 infection in thelast ten days?

• Fever or chills? • Shortness of breath? • Muscle or body aches? • Unusual headache? • New loss of taste or smell? • Nausea or vomiting? • Congestion or runny nose? • Difficulty breathing? • Fatigue? • Cough? • Sore throat? • Diarrhea?

• Question 2: Have you had a positive test for COVID-19 infection within the past ten (10) days?

• Question 3: Question3: Within the last ten (10) days, have you been within six (6) feet for longerthan 15 minutes with someone who has a suspected or confirmed COVID-19 infection,WITHOUT taking proper precautions like wearing a mask and frequently washing your handsduring this contact period?

Child’s name _______________________________________________

Signature____________________________________________ Date ______________________