Summer Camp “Leader” – 2019

Leader NY Camp LLC






 I, ______________________________________, as the parent/guardian do acknowledge that my child

                   print the parent/guardian name


 _______________________________ is in good health and is able to participate in Summer Camp “Leader”.  

                   print the Child’s name


           In consideration of Leader NY Camp LLC (DBA Camp “Leader”) agreeing to allow my child to participate in any and all summer activities (on-site and off-site) conducted by Leader NY Camp LLC.  I, parent or legal guardian, understand that participating in summer activities is an acceptance of some risk of injury. I, parent or legal guardian, do hereby for myself, my heirs, and assigns waive, release and discharge any and all claims for damages of any nature against the Leader NY Camp LLC, the Summer Camp “Leader” locations, our partners Leader NY Foundation Corp. and LID Foundation Inc, and the agents or authorized representatives conducting summer. This includes any and all injuries which may occur to my child as a result of participation in any activities sponsored, maintained and/or supervised by Leader NY Camp LLC (Summer Camp “Leader”) whether on or off-site.         

          I/we understand that the Summer Camp “Leader” does not provide medical insurance or medical services; therefore, proof of insurance is required.  (Note: Please attach a copy of child medical insurance card, front and back, to expedite medical treatment).    

           I, hereby release and discharge of all liabilities, and agree not to sue Leader NY Camp LLC, it’s affiliated organizations and sponsors, their instructors, center officials, employees and associated personnel, officers, directors, agents, including the owners/principals and lessors of premises used to conduct the Summer Camp “Leader” programs and the aforementioned activities.

           By signing this agreement I hereby give my consent and approval to the Leader NY Camp LLC, that they shall have the right, without obtaining my further approval, to photograph, take motion pictures of, televise, or reproduce in any manner or through any media, images of myself, my child, and my legal guardians.  The Leader NY Camp LLC shall have the right to display, use, sell or license any such Pictures or other reproductions for any purposes commercial or otherwise without monetary compensation to myself, my child or my legal guardian.   




       PRINTED NAME                                            SIGNATURES                                       DATE




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