Staff Only
___Early drop off ___ Late pick up
_____ Registration Number
Greek Peak Adventure Camp Registration Form
CHILD’S NAME:
FIRST
MI
LAST
DOB:________________________
GENDER:  Male  Female
LAST
DOB:________________________
GENDER:  Male  Female
LAST
DOB:________________________
GENDER:  Male  Female
CHILD’S NAME:
FIRST
MI
CHILD’S NAME:
FIRST
MI
SPECIAL/SPECIFIC INFORMATION:
Any special/physical needs:_________________________________________________________________
Allergies/Medications:_____________________________________________________________________
Other pertinent info:______________________________________________________________________
PARENT'S NAME:__________________________________________________________
PRIMARY PHONE:
_
SECONDARY PHONE:____________________________
HOME ADDRESS:_________________________________________________________________________
Street
City
State
Zip
EMAIL:
TO WHOM CAN YOUR CHILD BE RELEASED?
(Driver’s license/photo Id or security number must be presented at time of pick up.)
NAME: ______________________ RELATIONSHIP: _______________ CELL # :___________________
NAME: ______________________ RELATIONSHIP: _______________ CELL # :___________________
***IN CASE OF EMERGENCY & PARENT/GUARDIAN CAN NOT BE REACHED.***
PLEASE CONTACT:
NAME: ______________________ RELATIONSHIP: ______________ PHONE:______________________
Notes:
February 29, 2016
ACKNOWLEDGEMENT OF RISKS, RELEASE OF LIABILITY,
AND AUTHORIZATION FOR MEDICAL TREATMENT
We have staff on site certified in CPR/AED and First Aid.
A morning and an afternoon snack will be provided, PLEASE send child(ren) with lunch OR sign up in
advance for our “bag lunch option” *additional charge of $10 per day or $45 per week.
~~~TURN OVER, PLEASE READ & SIGN~~~
I consent to the enrollment of the children) listed above in this facility and am aware of the policies regarding fees and the
services provided by the facility.
In the event that the named minor should need medical attention while under the care and supervision of Greek Peak Staff,
I realize that every attempt will be made to contact me. If all reasonable steps to contact me are unsuccessful I agree that
in case of accident or injury, medical emergency care may be given in the event I or person(s) designated above cannot be
reached and I agree to pay for it.
I will provide special information on this registration form to assist the facility in caring for this child(ren) (diet, habits,
important medical information). If there is any change of information, I will bring it to the staff’s attention so they can
make note of it.
In consideration of my child being accepted into Greek Peak Adventure Camp, I, being the parent or guardian of the
minor(s), hereby acknowledge and accept the inherent and other risks that may exist. I further release and agree not to sue,
regardless of negligence, Greek Peak Mountain Resort (GPMR) their employees, representatives, assigns, agents and
sponsors “(other releases)”, on either my own behalf or on behalf of my child(ren), if my child(ren) is injured while
participating in the GP Adventure Camp. I further agree to fully indemnify and hold harmless GPMR and other releases
from and against any loss, liability, damage, cost, and expense which GPMR and other releases may incur or sustain as a
result of any claim arising from any personal injury suffered by the named minor(s), even if it is contended that they were
negligent.
This indemnification provision is distinct from and independent of the release provisions. It will apply whether or not the
release provisions are held invalid or inapplicable in whole or in part to any claim asserted.
I agree that all disputes under this contract and/or lawsuits arising from use of the facilities at GPMR shall be litigated
exclusively in the Supreme Court of the State of New York, County of Cortland, or in the United States District Court
New York.
1.Express Assumption of Risk.
I understand that participation in the Adventure Center activities, including but not limited to use of the Zip lines, Ropes
Challenge Course, Teambuilding Activities, Alpine Coaster, Tubing Center, Climbing Walls, Laser Tag, and Mountain
Bike Park involve significant risks of serious injury or death from, including but not limited to, falling, slipping, jolting,
jarring or shaking, impacting man made or natural objects or being impacted by such objects, equipment malfunction,
adverse weather conditions, natural elements, including, but not limited to, trees, rocks, stumps, and uneven terrain,
dizziness, fatigue, encounters with plants, insects or animals, contact with other participants or their personal property,
physical exertion, and falls. I acknowledge that I have sufficient skills and am in adequate physical condition to participate
in these activities, and that I understand and accept the risks of serious injury or death.
2. Participation of Minor.
I am the parent or guardian of the minor on whose behalf I have signed this agreement. I have explained the risks inherent
in the Adventure Center activities to my child in an age appropriate manner and he/she has acknowledged that he/she
understands and accepts those risks.
3. Right of Privacy Release.
I agree to the photographing, filming or videotaping of my appearance while visiting Greek Peak and the reproduction of
such materials by Greek Peak Holdings and its corporate affiliates (“Greek Peak”) for Greek Peak’s marketing materials
(“Materials”). I agree that Greek Peak is, and will be, the sole owner of all rights in and to the Materials and the
reproductions thereof. Greek Peak shall have the right, among other things, to reproduce the Materials one or more times
for any and all lawful purposes, including the promotion of Greek Peak’s business. Greek Peak shall also have the right to
use my name, portrait, picture and biographical material for such purposes. I agree to hold Greek Peak and any third
parties harmless against any liability, loss or damage, including reasonable attorneys’ fees caused by, or arising from, the
photographing and reproduction of my appearance for the Materials.
4.Effect on Legal Rights.
I have read this agreement carefully and understand its contents. I have read this agreement to my child and he/she has
acknowledged that he/she understands its contents I am aware that the agreement includes an express assumption of risk.
I understand that this agreement may affect legal claims for damages in the event of death or any injury to me or my child.
I acknowledge that any questions I or my child have about this agreement or the risks inherent in participating in the
Adventure Center activities have been answered to my and my child’s satisfaction. I have signed this document of my
own free will.
5.Controlling Law/Venue.
I agree that the terms of this agreement are binding on me and my child and shall be governed by the Laws of the State of
New York. I also agree that any legal action relating to my or my child’s participation in the Adventure Center activities
will be brought in the New York State Supreme Court, County of Cortland or the United States District Court for the
Northern District of New York.
6. Inclement Weather
I understand that hours and activities of Greek Peak Adventure Center are dependent upon weather. No guarantees or
refunds will be distributed.
Height, Weight and Age Requirements
 Mountain Coaster - Minimum 3 yrs. old & 38” tall to ride with adult 16+; 54” to ride alone; max weight 350 lbs.
 Zip Lines - Minimum 7 yrs. old & 48” tall; weight range 60-270 lbs.
 Eurobungy – Minimum 32” tall; weight range 40-200 lbs.
 Aerial Challenge Course – Minimum 7 yrs. Old & 48” tall, Blue 60” tall, Black 15 yrs. old; weight range 60-270 lbs.
 Bounce House/ Kiddie Climbing Wall – 3-6 yrs. old only
 Laser Tag – Minimum 6 yrs. old
PARENT/GUARDIAN SIGNATURE:____________________________________ DATE:______________
What you will need each day
1. Lunch (Shouldn't have to be heated or refrigerated). Must be marked
with child's name.
2. Closed toed shoes
3.Camp shirt
February 29, 2016
ACKNOWLEDGEMENT OF RISKS, RELEASE OF LIABILITY,
AND AUTHORIZATION FOR MEDICAL TREATMENT
4.Camp water bottle marked with child's name
5. Bathing suit and towel
6. Sunscreen