General Program (Gr. 2-7 completed) June 11 - August 3

Transcription

1 General Program (Gr. 2-7 completed) June 11 - August 3 Children participating in Friday Field Trips must have a field trip t-shirt to be worn on ALL trips. Please see Playground Leader. FRIDAY FIELD TRIPS and DUE DATES Butler Skateland Friday, June 15 Due - Wednesday, June 13 Skyzone Trampoline Park Friday, June 22 Additional Waiver Due - Thursday, June 14 Village Bowl Friday, June 29 Due - Thursday, June 21 Great America Friday, July 6 Due - Thursday, June 28 America s Action Territory Friday, July 13 Due - Thursday, July 5 Adventure Rock/ Friday, July 20 Urban Ecology Center Hike Due - Thursday, July 12 Salto Friday, July 27 Additional Waiver Due - Thursday, July 19 Mt. Olympus Water & Theme Park Friday, August 3 Due - Thursday, July 26 Visit us at for a complete schedule of field trips and bus schedules. Please see enclosed flyers for details. Fees and due dates are listed on the individual permission slips. Deliver all permission slips and money to the leaders at your playground or the Recreation Dept. on or before the due date. This will ensure that we have enough busses ordered. Some trips will have a limited amount of spaces, so get them in early. Please make checks payable to the Wauwatosa Recreation Department.

2 Friday, June 15 WHO: All registered General playground participants. WHEN: Friday, June 15 *Permission slips AND Money will not be accepted after WEDNESDAY, June 13* COST: $10.00 per child *Fee includes skate rental and bus ride* DEPARTURE TIMES: 8:30am at Lincoln Elementary (Southwest Playground) 8:40am at Eisenhower Elementary (South Playground) RETURN TIMES: 11:30am at Eisenhower Elementary (South Playground) 11:40am at Lincoln Elementary (Southwest Playground) BRING: SOCKS and money for snacks and games. Please make sure your child has socks to wear with their skates. PERMISSION SLIPS & MONEY WILL NOT BE ACCEPTED AFTER WEDNESDAY, JUNE 13. Permission Slip - Deadline June 13 COST: $10.00 per child I, the undersigned or the parent/guardian of the individual named which I agree to assume the liability. Furthermore, the individual named herein, are in good physical health, appropriate for the activities in which they are participating. I understand that the Wauwatosa School District does not provide accident insurance. In the event of a medical emergency and I cannot be reached, I authorize the Recreation Department staff to obtain medical treatment for my son/daughter/legal ward. BUTLER SKATELAND - JUNE 15 Activity# Address Phone PERMISSION SLIPS & MONEY WILL NOT BE ACCEPTED AFTER WEDNESDAY, JUNE 13.

3 Friday, June 22 WHO: All registered General playground participants. WHEN: Friday, June 22 *Permission slips and Money will not be accepted after THURSDAY, June 14* COST: $20.00 per child *Fee includes admission to SkyzoneTrampoline Park and bus ride* DEPARTURE TIMES: 7:45am at Lincoln Elementary (Southwest Playground) 8:00am at Eisenhower Elementary (South Playground) RETURN TIMES: 11:30am at Eisenhower Elementary (South Playground) 11:45am at Lincoln Elementary (Southwest Playground) PLEASE BRING ADDITIONAL SKYZONE WAIVER. Permission Slip - Deadline June 14 COST: $20.00 per child I, the undersigned or the parent/guardian of the individual named which I agree to assume the liability. Furthermore, the individual named herein, are in good physical health, appropriate for the activities in which they are participating. I understand that the Wauwatosa School District does not provide accident insurance. In the event of a medical emergency and I cannot be reached, I authorize the Recreation Department staff to obtain medical treatment for my son/daughter/legal ward. SKYZONE TRAMPOLINE PARK - JUNE 22 Activity# Address Phone PERMISSION SLIPS AND MONEY WILL NOT BE ACCEPTED AFTER THURSDAY, JUNE 14.

4 Participant Agreement, Release and Assumption of Risk (The Agreement) Sky Zone Milwaukee lete electronically at Please print and fill out highlighted areas completely or complete electronically at Must be completed for participants under the age of 18 (Print up to four names/birthdates below of children of the SAME parent or legal guardian): Participant 1: Print First Name Print Last Name Birthdate Participant 2: Print First Name Print Last Name Birthdate Participant 3: Print First Name Print Last Name Birthdate Participant 4: Print First Name Print Last Name Birthdate In consideration for gaining access to W229 N1420 Westwood Dr. Waukesha, WI 53186, (the Location ) and engaging the services of Innovative Heights Milwaukee, LLC, or any other location within the state of Wisconsin, d/b/a Sky Zone Indoor Trampoline Park, RPSZ Construction, LLC, Sky Zone Franchise Group, LLC, Sky Zone, LLC, their agents, owners, officers, directors, representatives, assigns, affiliates, volunteers, participants, employees, insurers, and all other persons or entities acting in any capacity on their behalf, (herein after collectively referred to as SZITP ), I on behalf of myself, my spouse, my children, my parents, my heirs, assigns, personal representatives, estate, and insurers, agree as follows: (Initial Here) I acknowledge that my participation in SZITP trampoline games or activities entails known and unanticipated risks that could result in physical or emotional injury including, but not limited to broken bones, sprained or torn ligaments, paralysis, death, or other bodily injury or property damage to myself my child(ren), or to third parties. I understand that such risks simply cannot be eliminated without jeopardizing the essential qualities of the activity. I expressly agree and promise to accept and assume all of the risks existing in this activity. My and/or my child(ren) s participation in this activity is purely voluntary and I elect to participate, or allow my children to participate in spite of the risks. If I and/or my child(ren) are injured, I acknowledge that I or my child(ren) may require medical assistance, which I acknowledge will be at my own expense or the expense of my personal insurer(s). I hereby represent and affirm that I have adequate and appropriate insurance to provide coverage for such medical expense. I UNDERSTAND AND AGREE THAT SZITP WILL NOT PAY FOR ANY COST OR EXPENSES INCURRED BY ME IF I AND/OR MY CHILD ARE INJURED UNLESS SUCH INJURY WAS CAUSED BY GREATER THAN ORDINARY NEGLIGENCE OF SZITP. In consideration of SZITP allowing my participation in trampoline games or activities, I for myself and on behalf of my child(ren) and/or legal ward, heirs, administrators, personal representatives, or assigns, do agree to hold harmless, release and discharge SZITP of and from all claims, demands, causes of action, and legal liability, whether the same be known or unknown, anticipated or unanticipated, due to SZITP s ordinary negligence: and I, for myself and on behalf of my child(ren) and/or legal ward, heirs, administrators, personal representatives, or any assigns, further agree that except in the event of SZITP s gross negligence and willfull and wanton misconduct, I shall not bring any claims, demands, legal actions and causes of action, against SZITP for any economic and non-economic losses due to bodily injury, death, property damage sustained by me and/or my minor child(ren) that are in any way associated with SZITP trampoline games or activities. Should SZITP or anyone acting on their behalf be required to incur attorney s fees and costs to enforce this Agreement, I for myself and on behalf of my child(ren), and/or legal ward, heirs, administrators, personal representatives or assigns, agree to indemnify and hold them harmless for all such fees and costs. (Initial Here). I certify that I am physically able to participate in all activities at the Location without aid or assistance. I further certify that I am willing to assume the risk of any medical or physical condition that I may have. I acknowledge that I have read the rules, (the SZITP Rules ) governing my and/or my child(ren) s participation in any activities at the Location. I certify that I have explained the SZITP Rules to the child(ren) listed in this waiver. I understand that the SZITP Rules have been implemented for the safety of all guests at the Location, including myself and/or my child(ren). I acknowledge that failure to follow the rules could result in the expulsion of myself and/or my child(ren) from the Location. I agree that if any portion of this Agreement is found to be void or unenforceable, the remaining portions shall remain in full force and effect. If there are any disputes regarding this agreement, I on behalf of myself and/or my child(ren) hereby waive any right I and/or my child(ren) may have to a trial and agree that such dispute shall be brought within one year of the date of this Agreement and will be determined by binding arbitration before one arbitrator to be administered by JAMS pursuant to its Comprehensive Arbitration Rules and Procedures. I further agree that the arbitration will take place solely in the state of Wisconsin and that the substantive law of Wisconsin shall apply. If, despite the representations made in this agreement, I or anyone on behalf of myself and/or my child(ren) file or otherwise initiate a lawsuit against SZITP, in addition to my agreement to defend and indemnify SZITP, I agree to pay within 60 days liquidated damages in the amount of $5,000 to SZITP. Should I fail to pay this liquidated damages amount within the 60 day time period provided by this Agreement, I further agree to pay interest on the $5,000 amount calculated at 12% per annum. I further grant SZITP the right, without reservation or limitation, to videotape, and/or record me and/or my child(ren) on closed circuit television. I further grant SZITP the right, without reservation or limitation, to photograph, videotape, and/or record me and/or my child(ren) and to use my or my child(ren) s name, face, likeness, voice and appearance in connection with exhibitions, publicity, advertising and promotional materials. I would like to receive free promotions and discounts to the address provided below. I may unsubscribe from s from Sky Zone at any time. By signing this document, I acknowledge that if anyone is hurt or property is damaged during my participation in this activity, I may be found by a court of law to have waived my right to maintain a lawsuit against SZITP on the basis of any claim from which I have released them herein. I have had sufficient opportunity to read this entire document. I understand this Agreement and I voluntarily agree to be bound by its terms. I further certify that I am the parent or legal guardian of the child(ren) listed above on this Agreement or that I have been granted power of attorney to sign this Agreement on behalf of the parent or legal guardian of the child(ren) listed above. Parent/Legal Guardian/Participant Signature (if 18 or older) Date: Parent/Guardian/Participant (if over 18): Print First Name Print Last Name Parent Birth date Print Street Address Apt. # Print City Print State ZIP Cell Phone Emergency Contact Number Check box if you would not like to receive free promotions and discounts to the address provided above, I may unsubscribe from s at any time. Waiver accepted by (SZITP Employee)

5 Friday, June 29 Come and enjoy the afternoon with your friends at Village Bowl in Menomonee Falls. Participants will have 3 games of bowling! Pizza or Hot Dogs will be served! Make a selection below. WHO: All registered General playground participants. WHEN: Friday, June 29 *All participants wishing to attend this event MUST SIGN-UP no later than THURSDAY, June 21*. COST: $20.00 per child *Fee includes lunch, shoes, bowling and bus ride* DEPARTURE TIMES: 10:15am at Lincoln Elementary (Southwest Playground) 10:30am at Eisenhower Elementary (South Playground) (Please drop off your child at the closer playground) RETURN TIMES: 1:45pm at Eisenhower Elementary (South Playground) 2:00pm at Lincoln Elementary (Southwest Playground) BRING: SOCKS and money (optional) for concessions! Permission Slip - Deadline June 21 COST: $20.00 per child I, the undersigned or the parent/guardian of the individual named which I agree to assume the liability. Furthermore, the individual named herein, are in good physical health, appropriate for the activities in which they are participating. I understand that the Wauwatosa School District does not provide accident insurance. In the event of a medical emergency and I cannnot be reached, I authorize the Recreation Department staff to obtain medical treatment for my son/daughter/legal ward. VILLAGE BOWL - JUNE 29 Activity# Address Phone Choose one: Pizza or Hot Dog Shoe size PERMISSION SLIPS AND MONEY WILL NOT BE ACCEPTED AFTER THURSDAY, JUNE 21.

6 Friday, July 6 WHO: Registered General playground participants who have completed 4th grade and up. **2nd and 3rd graders are WELCOME to attend with one parent chaperone (at least 16 years old). Each parent can be responsible for up to three participants. Each chaperone must attach a note stating who they will be responsible for. Each chaperone will have to pay for a Great America ticket. Minimum height for some rides is 54 WHEN: Friday, July 6 *Permission slips and Money will not be accepted after THURSDAY, June 28* COST: $40.00 (Does not include Hurricane Harbor) *Fee includes a ticket and bus ride* If you have a Great America ticket, cost is $10.00 (participant is responsible for their own ticket). DEPARTURE TIMES: 8:00am at Lincoln Elementary (Southwest Playground) 8:10am at Eisenhower Elementary (South Playground) RETURN TIMES: 5:15pm at Eisenhower Elementary (South Playground) 5:30pm at Lincoln Elementary (Southwest Playground) BRING: Do not bring any valuables. If you do, make sure they get locked up in a locker. A bag (lunch box or plastic bag) lunch (no refrigeration) or money to buy lunch and play games. Fee does not include Hurricane Harbor, please do not bring swimsuit and towel. Please wear Sunscreen. Lockers cost approx. $14 - $20. Permission Slip - Deadline June 28 Cost: $40.00 per child If you have a Great America ticket, cost is $10.00 (participant is responsible for their own ticket). I, the undersigned or the parents/guardian of the individual named which I agree to assume the liability. Furthermore, the individual named herein, are in good physical health, appropriate for the activities in which they are participating. I understand that the Wauwatosa School District does not provide accident insurance. In the event of a medical emergency and I cannot be reached, I authorize the Recreation Department staff to obtain medical treatment for my son/daughter/legal ward. GREAT AMERICA - JULY 6 Activity# Address Phone PERMISSION SLIPS AND MONEY WILL NOT BE ACCEPTED AFTER THURSDAY, JUNE 28.

7 Friday, July 13 WHO: All registered General playground participants WHEN: Friday, July 13 *Permission slips and money will not be accepted after THURSDAY, July 5* COST: $20.00 per child *Fee includes admission ticket and bus ride.* DEPARTURE TIMES: 9:00am at Lincoln Elementary (Southwest Playground) 9:15am at Eisenhower Elementary (South Playground) RETURN TIMES: 3:45pm at Eisenhower Elementary (South Playground) 3:55pm at Lincoln Elementary (Southwest Playground) BRING: A bag (lunch box or plastic bag) lunch (no refrigeration) or money for the concession stand. Visit our website at for a complete schedule of summer fieldtrips and bus schedules. Permission Slip - Deadline July 5 Cost: $20.00 per child I, the undersigned or the parent/guardian of the individual named which I agree to assume the liability. Furthermore, the individual named herein, are in good physical health, appropriate for the activities in which they are participating. I understand that the Wauwatosa School District does not provide acccident insurance. In the event of a medical emergency and I cannot be reached, I authorize the Recreation Department staff to obtain medical treatment for my son/daughter/legal ward. AMERICA S ACTION TERRITORY - JULY 13 Activity# Address Phone PERMISSION SLIPS AND MONEY WILL NOT BE ACCEPTED AFTER THURSDAY, JULY 5.

8 Friday, July 20 Enjoy a unique climbing experience at Adventure Rock and take in a nature hike to Urban Ecology Center. WHO: All registered General playground participants WHEN: Friday, July 20 *Permission slips will not be accepted after Thursday, July 12* COST: $15.00 per child DEPARTURE TIMES: 8:00am at Lincoln Elementary (Southwest Playground) 8:15am at Eisenhower Elementary (South Playground) RETURN TIMES: 1:45pm at Eisenhower Elementary (South Playground) 2:00pm at Lincoln Elementary (Southwest Playground) BRING: a bag (lunch box or plastic bag) lunch, (No refrigeration). Permission Slip - Deadline July 12 Price - $15.00 I, the undersigned or the parent/guardian of the individual named Wauwatosa School District and its employees, officers, and agents from and against any and all liability resulting from participation in the activities listed above. I understand that the program in which I am enrolling, like all activity programs, have some inherent risk, for which I agree to assume the liability. Furthermore, the individual named herein are in good physical health, appropriate for the activities in which they are participating. I understand that the Wauwatosa School District does not provide accident insurance. In the event of a medical emergency and I cannot be reached, I authorize the Recreation Department staff to obtain medical treatment for my son/daughter/legal ward. ADVENTURE ROCK/URBAN ECOLOGY - JULY 20 Activity# Address Phone PERMISSION SLIPS WILL NOT BE ACCEPTED AFTER THURSDAY, JULY 12.

9 Participant First Name Participant Last Name Date of Birth Address City State Zip Phone Emergency Contact Emergency Phone In consideration of the use of the premises, facilities and services of Adventure Rock, Inc. ( AR ), a Wisconsin corporation, I, an adult visitor (eighteen years of age or older) or the parent or legally appointed guardian ( Parent ) of a visitor who is a minor ( Minor ), understand, acknowledge and agree as follows: The Facilities: Adventure Rock owns and operates multiple climbing facilities in the State of Wisconsin. This agreement applies to the actives in and of all of Adventure Rock s facilities. Activities: I understand that the activities offered by AR include the following: climbing on and rappelling from artificial indoor walls; bouldering; the use of auto belays and manual belay systems; slacklining; independent and group exercising, including the use of exercise equipment; classes; programs; teams; competitions; and otherwise moving about AR premises and its outside perimeter ( Activities ). While an orientation will be provided for some Activities, and certain classes and programs are attended by staff, visitors should not assume that they are being supervised or observed in their Activities. Risks: I understand that the Activities require moderate to heavy physical exertion and represent that neither I, nor the Minor (if applicable), has any mental or physical condition that might create risks to myself (or to the Minor), or to others. I understand that climbing and other Activities of AR are dangerous and that visitors will be exposed to risks including, among others, the following: (1) slips, falls or collisions while using the facilities, rock climbing walls, floors, landing areas, entrances and exits, and any other facilities or equipment; (2) misuse of equipment (including, importantly, failure to properly clip into and operate the auto belays) and facilities; (3) failure of equipment, including but not limited to worn or defective safety equipment; (4) my, or the Minor s, physical strength, coordination, sense of balance or ability to give or follow directions when climbing, belaying, using an auto belay or otherwise participating in Activities; (5) entanglements with ropes or equipment; (6) bad decision making by me or the Minor, including, if I am an adult visitor or Parent, while assisting the Minor in Activities; (7) the acts or omissions of other persons, including staff, which might include inadequate or faulty instructions; (8) falling climbers or dropped ropes, climbing hardware, wall components, or other items or personal effects ( Risks ). These Risks and others are inherent to AR, its Activities and premises; they cannot be eliminated without destroying the basic nature of a visit to AR and participation in its Activities. Assumption of Risks: I understand that the Risks described above, and others, inherent or not, may result in all manner of trauma including breaks, sprains, abrasions, serious injury and even death. I acknowledge and assume all such Risks, inherent and otherwise, whether or not described above. I will carefully read and comply with the guidelines and warnings and instructional signage of AR. If the visitor is a Minor, I, Parent, have discussed the guidelines, Activities and Risks with the Minor who understands them and wishes to participate nevertheless. Brookfield Milwaukee PH Fax Continued onto Page 2 Page 1 of 2

10 Release and Indemnity: I, for myself or on behalf of the Minor, agree to release, not to sue, and to defend and indemnify (that is, to defend and pay or reimburse damages and costs, including attorneys fees), Adventure Rock Inc., its owners, directors, officers, volunteers, and employees ( Released Parties ) with respect to any claim related in any way to my, or the Minor s, visit to AR or participation in any Activities of AR. These agreements of release and indemnity include loss or damage caused or claimed to be caused in whole or in part by the negligence, but not the intentional wrongs or gross negligence, of a Released Party. Other: I understand that AR offers free protective headgear for my or the Minor s use. I assume all risks of using or not using such protective headgear. I hereby give AR my permission and consent to take photographs, video, and other images of me or the Minor without compensation. In the event I or the Minor suffer any injury, however minor, while at AR, I agree to notify an employee of AR immediately. The terms of this agreement and any dispute between a Released Party and a visitor or Parent, related to this agreement or otherwise, will be governed by the substantive laws (not including laws which might apply the laws of another jurisdiction) of the State of Wisconsin. Any suit or mediation of the dispute will take place solely in Waukesha County, Wisconsin. I consent to the jurisdiction of such courts, for myself or on behalf of the Minor. This document is intended to be binding, to the fullest extent of the law, on all persons signing below, the Minor, if any, and their respective successors, heirs, executors, administrators and family members. It may not be altered. If any part of this document is deemed by a court of competent jurisdiction to be unenforceable the remainder shall nevertheless be in full force and effect. This agreement will govern visits to the premises of AR on the date on which it is signed and thereafter until it is withdrawn or replaced by a subsequent agreement which will apply to visits thereafter. The terms of this agreement, including the agreements of release and indemnity, are subject to negotiations, which may include enlargement of fees or other financial obligations for the visitor or Parent. I have read and consent/agree to the terms and conditions herein, on behalf of myself or said Minor (if applicable). WARNING: A person who falsifies his or her signature below or misrepresents the capacity (for example, as being at least 18 years old or as being the Parent) in which they sign will be considered a FORGER and in addition to other civil and criminal penalties will be deemed to have agreed to indemnify the Released Parties from and against any claim of loss asserted by or on behalf of a person whose visit to AR was facilitated by that forgery. If 18 or older: Participant Signature: Date: If signing on behalf a Minor: Minor s Printed Name: Parent Signature: Date: Parent Printed Name: Parent Phone # Brookfield Milwaukee PH Fax Page 2 of 2

11 Friday, July 27 WHO: All registered General playground participants. WHEN: Friday, July 27 *Permission slips and money will not be accepted after THURSDAY, July 19* COST: $15.00 per child *Fee includes admission to Salto and bus ride* DEPARTURE TIMES: 12noon at Lincoln Elementary (Southwest Playground) 12:15pm at Eisenhower Elementary (South Playground) RETURN TIMES: 3:30pm at Eisenhower Elementary (South Playground) 3:40pm at Lincoln Elementary (Southwest Playground) PLEASE BRING ADDITIONAL SALTO WAIVER. *PLEASE MAKE SURE YOUR CHILD WEARS SOCKS FOR THEIR SAFETY.* Permission Slip - Deadline July 19 COST: $15.00 per child I, the undersigned or the parent/guardian of the individual named which I agree to assume the liability. Furthermore, the individual named herein, are in good physical health, appropriate for the activities in which they are participating. I understand that the Wauwatosa School District does not provide accident insurance. In the event of a medical emergency and I cannot be reached, I authorize the Recreation Department staff to obtain medical treatment for my son/daughter/legal ward. SALTO GYMNASTICS - JULY 27 Activity# Address Phone PERMISSION SLIPS AND MONEY WILL NOT BE ACCEPTED AFTER THURSDAY, JULY 19.

12 GUEST S NAME Birthdate Age PARENT S NAME: ADDRESS: City/State/Zip Code PHONE #: My son/daughter has my permission to attend a field trip for Wauwatosa Recreation Department on Friday, July 27. I understand and agree that Salto, Inc. and it s staff will assume no responsibilities for injuries or medical expenses while attending this field trip. This field trip is based on physical activity. Please dress appropriately. Parent s Signature: Date

13 Friday, August 3 WHO: Registered General playground participants. WHEN: Friday, August 3 *Permission slips and money will not be accepted after THURSDAY, July 26* COST: $15.00 *Fee includes a ticket and bus ride* If you have a Mt. Olympus ticket, the cost is $5.00 (participant is responsible for their own ticket). DEPARTURE TIMES: 7:00am at Lincoln Elementary (Southwest Playground) 7:10am at Eisenhower Elementary (South Playground) RETURN TIMES: 5:45pm at Eisenhower Elementary (South Playground) 6:00pm at Lincoln Elementary (Southwest Playground) BRING: Do not bring any valuables. If you do, make sure they get locked up in a locker. A bag (lunch box or plastic bag) lunch (no refrigeration) or money to buy lunch and a locker. Towel & Sunscreen. Change of clothes. Lockers cost $10 + tax. Participants will receive $5 back when they turn in their key. Permission Slip - Deadline July 26 Cost: $15.00 per child If you have a Mt. Olympus ticket, cost is $5.00 (participant is responsible for their own ticket). I, the undersigned or the parents/guardian of the individual named which I agree to assume the liability. Furthermore, the individual named herein, are in good physical health, appropriate for the activities in which they are participating. I understand that the Wauwatosa School District does not provide accident insurance. In the event of a medical emergency and I cannot be reached, I authorize the Recreation Department staff to obtain medical treatment for my son/daughter/legal ward. MT. OLYMPUS - AUGUST 3 Activity# Address Phone PERMISSION SLIPS AND MONEY WILL NOT BE ACCEPTED AFTER THURSDAY, JULY 26.