KIPPEWA FOR GIRLS
Mailing Address:
1 Kippewa Drive
Monmouth, ME 04259
tel: (800) 547-7392
fax: (207) 933-2996
Directors:
Ginger and Steve Clare
www.kippewa.com / [email protected]
Ed Cunningham Retirement Party Registration Form
(Shhh! It’s a surprise!)
Camp Kippewa is proud to host a celebration of the 50 year Kippewa camping career of Ed
Cunningham as part of “Family Camp 2015.” We have four ways to celebrate this milestone
with Ed; attend his Clambake Retirement Party on the evening of Friday August 21st,
spend the day at Kippewa, stay the night at Kippewa, or join Ed for Family Camp 2015!
Family Name_______________________________________________________________________
Address___________________________________________________________________________
REGISTRATION DETAILS AND FEES
Clambake Party Registration Only:
Friday August 21: Arrive after 4pm, dinner at 5:30pm:
Adults/Children 12-18: $25, Children 4-11: $10
Play for the Day:
City__________________________________________________State_________ Zip_____________
Friday August 21: Includes camp activities, lunch and
Ed’s party. Arrive after 9am: Adults: $100,
Children 12-18: $80, Children 4-11: $40
Home Phone___________________________ Contact Email________________________________
Stay and Play:
Parent 1 Name (first & last)__________________________________________________________
Work Phone_______________________________ Cell Phone________________________________
Parent 2 Name (first & last)__________________________________________________________
Work Phone_______________________________ Cell Phone________________________________
Adult 1 Name (first & last)____________________________________________________________
Adult 2 Name (first & last)____________________________________________________________
Child 1 Name________________________________________ Date of Birth____________________
Child 2 Name________________________________________ Date of Birth____________________
Child 3 Name________________________________________ Date of Birth____________________
Child 4 Name________________________________________ Date of Birth____________________
TOTAL ADULTS__________________ TOTAL CHILDREN 12-18_____________
TOTAL CHILDREN 4-11___________ TOTAL CHILDREN 0-3 (no fee)_________
REGISTRATION: See details and fees at right.
q CLAMBAKE PARTY REGISTRATION ONLY: Friday August 21
q PLAY FOR THE DAY: Friday August 21
q STAY AND PLAY: Friday August 21 to Saturday August 22
q VACATION WITH ED: Stay 3 or more nights at Family Camp
q Full Session: Sunday, August 16 to Saturday, August 21
q Per Night: Please indicate the nights your family will attend camp (3 night minimum)
q Sun., August 16 q Mon., August 17
q Tues., August 18
q Wed., August 19 q Thurs., August 20
q Fri., August 21
CLAMBAKE PARTY ENTRÉE CHOICES: Please indicate number (one per guest)
Lobster__________ Steak__________ Chicken__________ Vegetarian__________
Friday August 21 to Saturday August 22: Includes
activities, meals, Ed’s party and overnight
accommodation. Arrive after 9am Friday, depart after
breakfast Saturday: Adults: $145,
Children 12-18: $120, Children 4-11: $95
Vacation with Ed:
(Stay 3 or more nights at Family Camp)
Full Session: Sunday, August 16 to Saturday, August 21
Adults: $810, Children 12-18: $690,
Children 4-11: $540
Per Night: Adults: $145; Children 12-18: $120;
Children 4-11: $95
Check in: 3:00 pm on arrival day.
Check out: 11:00 am on departure day.
DEPOSIT AND TUITION INFORMATION
FOR SINGLE DAY OR PARTY REGISTRATION ONLY:
No deposit required but payment due by August 1, 2015
FOR ANY OVERNIGHT REGISTRATION:
50% or $250 deposit required (includes $100 nonrefundable application fee) to accompany registration.
(See reverse side for payment terms and policies)
TUITION INFORMATION:
All tuition and fees are fully refundable (less the $100
application fee) until June 1, 2015. Balance is due by
July 1st.
Tuition includes all accommodations, meals, activities,
out of camp trips, linens and towels.
PAYMENT
Deposit Amount: $________________ (see details above)
You may charge your deposit (minimum due at registration)
and any additional amount up to the full tuition at this time.
TOTAL PAYMENT: $_______________
q Check: Make payable to Camp Kippewa
q Credit Card: q Visa q MasterCard q Amex
I have read and accept all of the terms and conditions set forth on BOTH SIDES of this
Enrollment Application as well as the attached waterfront regulations.
Card Number_________________________________________
Parent/Guardian Signature_________________________________ Date_________________
Billing Address________________________________________

Exp. Date_________________ Sec. Code_________________
City_______________________ State_______ Zip___________
IMPORTANT: See the reverse side of this form for Payment and Cancellation
Information and Terms and Conditions of Enrollment.
Cardholder Name_____________________________________
Cardholder Signature__________________________________
2015 TERMS AND CONDITIONS
1. RULES AND REGULATIONS: The individuals
named on the attached Enrollment Form (collectively the “Family”) and each individual (singly the
“Camper”) agree to abide by all of the rules and
regulations established by Kippewa for Girls Family
Camp (“Camp”) including, without limitation, those
relating to enrollment and withdrawal of Campers
and their Families. A copy of the Camp’s Waterfront
Regulations is appended to these Terms and
Conditions and is incorporated by reference herein.
Campers and their guests will conform to all directives of Camp, the Camp Director (the “Director”)
and the Camp’s staff members. Failure to do so will
constitute a material breach of this Agreement and
may result in dismissal from Camp.
2. PAYMENT AND CANCELLATION: Payment terms
are a $250 deposit to accompany enrollment
(includes $100 non-refundable application fee); Final
payment due July 1, 2015. There will be a $100 late
fee for all payments received after July 15 and a
$200 late fee for all payments received after August.
All cancellations must be in writing.
3. SAFETY AND STANDARDS: Campers and Families
will receive a written or verbal Safety Orientation and
will be responsible to relay the information conveyed
to all Camper participants and their guests. Kippewa
is a member of the American Camp Association
(“ACA”) and is required to comply with all ACA standards of conduct and operation. Any failure by a
camper to comply with the rules mandated by these
standards may, at the discretion of Camp Kippewa,
result in immediate termination of a camper’s stay
and forfeiture of all payments to Kippewa. A copy of
the ACA Standards will be maintained at the Facility
and provided to the Campers on request.
4. SMOKING AND ILLEGAL DRUGS NOT PERMITTED: Smoking and illegal drugs are not permitted at Camp.
Campers found to be smoking or in the possession of illegal drugs shall be subject to immediate
dismissal from Camp, in which case no refunds will
be made.
5. ALCOHOLIC BEVERAGES: Alcoholic beverages
are not permitted at Camp unless provided by Camp
as part of an on-site activity. Campers should not
bring any alcohol onto camp property. Any alcoholic
beverages provided by Camp should only be consumed in areas designated by the Camp for such
consumption. If unauthorized alcoholic beverages
are found in the possession of a Camper, the Camp
staff shall have the right to immediately dismiss
the Camper and require the Camper and its Family
to immediately vacate the Camp; in which case no
refunds will be made.
6. DISMISSAL OF CAMPER: The Camp reserves the
right to dismiss, in its sole discretion, any Camper
whose condition, conduct, influence or behavior is
deemed unsatisfactory or detrimental to the best
interests of the Camp or other Campers or who violates Camp rules and regulations, in which case no
refunds will be made.
7. DAMAGE TO PROPERTY: Each Camper and its
Family agrees to pay for any damages (including but
not limited to graffiti) to Camp property, buildings,
facilities, equipment, or loss of equipment arising
out of the Camper’s use of the Camp.
8. ACCOMMODATIONS; CLEANING: Camp provides
basic cabin style sleeping accommodations. Camp
will clean all bathroom facilities at least once a day
and provide rubbish removal service. In addition;
Camp will make reasonable efforts to keep the facilities clean.
9. MEDICAL CARE: Camp will have a nurse available
on-site for first aid and distribution of over-the-counter medications. Care provided by the Camp nurse
is included in the tuition. Should it be necessary for
the well being of the Camper to use outside medical
care, all expenses involved will be paid by Camper.
Emergency care will be provided by local 911 service.
Use of the Camp nurse is at the Camper’s discretion and Camper and its Family shall hold the Camp
harmless from any damages resulting from the care.
10. UNDERSTANDING AND ASSUMPTION OF RISK:
All Campers expressly understand that camp activities involve a degree of risk and understand that
accidents and injuries may occur in the natural
course of participation in such activities. Campers
expressly agree that they assume the inherent risk
associated with such activities, which include, without limitation, swimming, water sports, land sports,
certain crafts such as jewelry making, etc and agree
to hold the Camp harmless from any damages resulting from the activities.
11. SUPERVISION OF MINORS: Except with respect
to activities directly supervised by Camp (e.g. waterskiing), Campers who are parents or legal guardians
of minor Campers (collectively, “Parent”) are responsible to supervise their children (or children over
whom they have legal guardianship). Parent will be
responsible for any harm or damage caused by or to
such children and shall hold Camp harmless.
12. IMAGES, ETC: Permission is hereby given for
Camp to use in promoting the Camp and in other
ventures directly relating to the Camp (i) digital, photographic, video, and audio images or likenesses of
Camper; and (ii) statements, articles, names, music,
art, photographs, audio recordings, films and videos
created by Camper or originating from Camp or from
a Camp-related activity.
13. BELONGINGS: Camp is not responsible for
Camper’s belongings or equipment while in transit
or at Camp.
14. TIPPING: Tipping of staff is prohibited.
15. COLLECTION: If tuition or fees are not paid in
full for Camper, Camper will be liable for all costs of
collection, including attorney’s fees.
16. INDEMNIFICATION: In consideration for and
as a condition to the Camper being admitted to the
Camp, to the fullest extent permitted by law, Parents
on behalf of themselves, their spouse, heirs, personal representatives, or assigns, herby agree to
hold harmless, defend and indemnify Camp, its
employees, affiliated entities, parent companies,
directors, officers, managers, agents and owners
(collectively, the “Indemnified Parties”) against any
loss, costs, expenses (including attorney’s fees)
liabilities and damages arising from (a) Parent or
Camper’s breach of this Agreement; (b) Camper’s
violation of any rules, regulations or policies established by the Camp; (c) claims brought by Parent
or Camper; and/or (d) claims by Camp to collect
tuition, fees or other losses or damages.
17. SEVERABILITY: Camper and Parent expressly
agree that the provisions contained within the
Terms and Conditions portion of this agreement are
intended to be as broad and inclusive as permitted
by applicable law and that if any portion of the Terms
and Conditions are held invalid, it is agreed that the
balance of the agreement, including the remaining
Terms and Conditions, shall, notwithstanding, continue in full force and effect.
18. INTEGRATION: I/we affirm that this agreement
supersedes any and all previous oral or written
promises or agreements. I understand this is the
entire agreement between the parties and cannot be
modified or changed in any way by representations
or statements made by any agent or employee of
Camp. This agreement may only be amended by a
written document duly executed by all parties.
19. EFFECTIVE DATE; DISPUTES: This Application
of Enrollment (the “Agreement”) shall take effect
and become binding when (a) signed by at least one
of Camper’s parents and/or guardians, (b) returned
to Camp, and (c) accepted by Camp, which shall be
deemed to occur at the latest when the Camper is
permitted to begin attending the Camp. All claims,
lawsuits, disputes or causes of action of any kind or
nature, whether arising in law or in equity asserted
by Camper or Parent against the Camp and arising from or related to this Agreement or from the
Camper’s attendance at Camp shall be brought and
maintained exclusively in the courts of the State of
Maine (Kennebec County), and Parent and Camper
expressly submit to the jurisdiction of such courts.
The substantive law of the State of Maine will govern
such disputes without regard to conflict of law rules.
Please sign the front of this application indicating that you have read and accept all of the
above mentioned terms and conditions including the payment and cancellation policy.
Kippewa Family Camp
waterFront regulations
laKeFront aCCess anD rules:
Campers understand and agree that Campers will not have access to the Camp’s lake (Lake
Cobbosseeconte), either for swimming or boating unless the lake is opened by the Camp for
sanctioned water-based activities.
Campers will have aCCess to the waterFront FaCilities unDer the
Following rules:
• No camper will be permitted to access the waterfront or surrounding facilities without a Camp
lifeguard on duty.
• Activities at the waterfront will only be authorized under the direct supervision of Camp lifeguards
and staff.
• Swimming will only be permitted in defined areas. Campers may swim in the “Waders” area. This
area will be sectioned off. If campers wish to swim in the deeper sectioned off swim areas of the
dock system they must either (i) take and pass a swim test or (ii) wear a life vest.
• Swimming is not permitted outside of the sectioned off areas of the Kippewa lakefront, whether
or not a life vest is worn.
• All campers will go through a waterfront orientation prior to partaking in waterfront activities. Any
Camper that is not present for the initial waterfront orientation will be required to go through
separate orientation before gaining access to the waterfront.
• Campers will not use any boat, canoe, kayak, or other waterfront recreational items unless this
activity is sanctioned by, and is run under the direct supervision of Camp staff.
• Camp Kippewa Lakefront rules will be posted on site. Failure to follow the posted rules and the
rules noted above will result in the forfeiture of the right to use the waterfront facilities and may
result in dismissal from Camp.
We have read and accept all of the above mentioned waterfront regulations.
signature: ____________________________________________ Date: ________________