Camp Discovery Packet

Camp Discovery Packet 2022

Please complete and submit this packet by April 30, 2022.

Step 1 of 5

Camping Experience Information
Has your camper ever spent the night away from home and away from parents/guardians?*
- Yes
- No
Share any additional information.*
Has your camper previously attended AuSM's Camp Discovery?*
- Yes
- No
How was the experience?
Has your camper previously attended AuSM's Camp Hand in Hand?*
- Yes
- No
Has Dustin Suggs or Sarah Hauer recommended the move to Camp Discovery?
Please describe your camper's swimming ability. True Friends/Courage North requires all campers to show their swimming ability by first swimming with a small group, not an individual test. Please prepare your camper by letting them know about this in advance.*

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Address Book
The Autism Society of Minnesota would like permission for your son/daughter to be included in a camp directory. The camp directory is for the sole use of campers and staff to build and maintain friendships. Please fill out the information that you are willing to have in the camp directory. ONLY add this information if you want it to be shared in the Address Book.
Add address if you would like to be included in the address book
Street Address Address Line 2 City State ZIP Code
Releases
True Friends

Attendance Release: I hereby give my permission for the applicant named above, to participate in True Friends (TF) sponsored and supervised programs. I certify that the information on the application is true, accurate and complete. TF emphasizes safety first; however, participation in TF programs has inherent risks that may result in injury. I acknowledge and accept this fact and agree to hold harmless TF, its employees, and agents.

Photos

Release and Authorization for Use of Photographs, Images, Video and/or Sound Recordings
I hereby grant True Friends and all of its subsidiaries, the irrevocable right and permission, throughout the world, in connection with the photograph(s), images, video or sound recordings that were taken of me by, or which I provided to, True Friends the following: the right to use and reuse, in any manner at all said photographs, images, video, and/or sound recordings in whole or in part, modified or altered, either by themselves or in conjunction with other photographs, images, video and/or sound recordings, in any medium or form of distribution, and for any purposes whatsoever including, without limitation, all promotional, marketing and advertising uses, and other trade purposes, as well as using my name in connection therewith, if True Friends so desires. This permission is granted in perpetuity.

I hereby forever release and discharge True Friends from any and all claims, actions and demands arising out of or in connection with the use of said photographs, images, video and/or sound recordings including, without limitation, any and all claims for invasion of privacy and libel. This release shall inure to the benefit of the assigns, licensees and legal representatives of True Friends.
Participants/Guardian on behalf of Participant:
Please check your preferred option.*
- Yes. I agree to allow True Friends to use photograph(s), images, video or sound recording as stated above.
- No. I do NOT allow True Friends to use photograph (s), images, video or sound recording as stated above.
By stating no, the participant will NOT be featured in group, or activity photos during their stay.
AUTISM SOCIETY OF MINNESOTA (AuSM) CAMPS CONSENT FORM FOR INFORMATION

To provide you with services through the Autism Society of Minnesota (AuSM) Camps, AuSM may need to use and disclose health-related information about you and/or your child.

I AUTHORIZE AuSM to use and disclose my/my child’s name and disability information as follows: my/my child’s contact information, information about my/my child’s physical health, mental health or other services, and payment for services.
I also authorize AuSM to:
• Use information about me/my child to provide services to me/my child and to communicate across departments within AuSM to coordinate my/my child’s services.
• Disclose information to third party entities such as: insurance companies, or other government or private payers, in order for AuSM to obtain payment for its services.
• Use and disclose information about me/my child, as necessary, for the purpose of AuSM operations, such as case management, quality assurance and staff training.
Disclose:
• My name, address, telephone number, e-mail address.
• To include this information in the camp roster given to campers, staff and/or program volunteers.
• To assist in communication regarding camp, AuSM and community events.
• I/my child will be identified by name as a normal part of camp life.
I understand that:
• This authorization must be filled out completely to be valid.
• Once information is released to a third-party according to this authorization, AuSM cannot prevent its re-disclosure.
• This authorization does not limit the ability of AuSM to use or disclose my/my child’s health information as other wise permitted by state or federal law.
As part of the camp experience, your child may be photographed or video recorded alone or with other campers and/or staff. AuSM may use these photographs/videos in certain promotional or educational programs related to camp. Your child’s image could appear in these materials unless you decline permission below. If you decline permission then your camper’s photo will not be taken or shared by camp staff. If you decline, your camper’s photo will not be posted to the private camp Facebook either.
- No - AuSM does not have permission to use such photograph/videos of my child for such purposes. If you check the “NO” box your camper will not appear in the photos on the private camp Facebook Page.
AUTISM SOCIETY OF MINNESOTA (AuSM) WAIVER AND RELEASE OF LIABILITY AGREEMENT

I hereby agree, for myself and on behalf of my child and/or legal ward, heirs, administrators, personal representatives, assigns, and/or guests, if any, to the following:

The camper/guardian has read and understands all the information in this application and acknowledges that a wide variety of activities are conducted at Autism Society of Minnesota (AuSM) camps and gives permission for the camper named above to participate in these activities assuming all ordinary risks normally inherent to the nature of the activities. It is also understood that the camper may be transported and be out of camp while on a field trip or camping trip.

That in consideration of AuSM allowing use of camp programs at various locations and participation in its activities, under the terms set forth herein, I agree to hold harmless, release and discharge AuSM, its owners, agents, employees, personnel, sponsors, officers, directors, representatives, assigns, members, affiliated organizations, insurers, and others acting on its behalf (hereinafter collectively referred to as “ASSOCIATES”), of and from all claims, demands, causes of action and legal liability, whether the same be known or unknown, anticipated or unanticipated, due to AuSM and/or its ASSOCIATES’ ordinary negligence; and I do further agree that, except in the event of AuSM and/or its ASSOCIATES’ gross negligence and willful and wanton misconduct, I shall not bring any claims, demands, legal actions and causes of action, against AuSM and/or its ASSOCIATES as stated above in this clause, for any economic and/or non-economic losses due to bodily injury, death, property damage sustained by me and/or my minor children and/or legal wards, if any, in relation to the premises and/or operations of AuSM.

That if I engage in any physical activity or use of any camp facility on the premises, I agree to do so at my own risk and assume the risk of any and all injury and/or damage while engaging in any physical activity or use of any camp facility on the premises. My assumption of risk includes, but is not limited to, my use of any facility items (see Camp Waiver/Release form). I agree to assume this risk in my participation in any activity, class, program, service, instruction or AuSM sponsored event. I agree that I am VOLUNTARILY participating in camp activities and using camp facilities and premises and assume all risk of injury, harm, damage, or loss to me and my property that might result, including, without limitation, any loss or theft of any personal property. In the event of illness or injury to my child, I authorize any official representative of AuSM a to administer and/or secure medical treatment as deemed necessary by said representative.

This Agreement shall be governed by the laws of the State of Minnesota. If any of its provisions are held to be invalid or unenforceable by a court of competent jurisdiction, such holding shall not invalidate any of the other provisions of this Agreement, it being intended that the provisions of this Agreement are severable.

I attest that the camper is fit and prepared to use camp facilities and participate in camp activities. I ACKNOWLEDGE THAT I HAVE CAREFULLY READ THIS WAIVER AND RELEASE AND FULLY UNDERSTAND THAT IT IS A RELEASE OF LIABILITY AND EXPRESS ASSUMPTION OF RISK. I AM AWARE AND AGREE THAT BY SIGNING THIS WAIVER AND RELEASE, I AM GIVING UP MY RIGHT TO BRING LEGAL ACTION OR ASSERT A CLAIM AGAINST Autism Society of Minnesota FOR ITS NEGLIGENCE OR FOR ANY DEFECTIVE PRODUCT ON THE CAMP PREMISES. I HAVE READ AND VOLUNTARILY SIGNED THE WAIVER AND RELEASE AND FURTHER AGREE THAT NO ORAL REPRESENTATIONS, STATEMENTS OR INDUCEMENT APART FROM THE FOREGOING WRITTEN AGREEMENT HAVE BEEN MADE.
Further, I understand that this Agreement also waives and releases the Autism Society of Minnesota from any liability for negligence causing any injury to my child and/or legal ward, heirs, administrators, personal representatives, assigns, and/or guests, if any. I attest that they are fit and prepared to utilize camp facilities and participate in camp activities.
AuSM Camp Policy Agreement
Please see the Camp Discovery Policies and Procedures Guide linked in your placement e-mail. Note that it is of the utmost importance that you read and understand the COVID-19 policy to help keep all of our campers safe. By initialing below you confirm that you have read and understood the following policies provided by AuSM:
Given the ever-changing nature of COVID-19 guidance, AuSM has decided to notify families of final COVID guidelines related to camp no later then May 13, 2022. These guidelines will not include a vaccine mandate, but will reflect the most up to date guidance from the CDC and Minnesota Department of Health. We are committed to the health and safety of all our campers and staff. By initialing here, I acknowledge that AuSM will be communicating a final COVID consent form at that time. This form will be required in order to attend camp.*
Service Policy*
Registration Policy*
Cancellation Policy*
Electronics Policy*
Special Diet Policy*
Clothing & Personal Inventory Policy*
Medication Handling Policy*
Swimmer's Itch Policy*
Phone Call Policy*
By typing your name here, you acknowledge that you have read, understood, and consented to the terms of the information provided above as well as accept and voluntarily participate, knowing the inherent risk due to the nature of the activities. You agree to AuSM's policies and True Friend's policies.*
First Last
Date*
MM slash DD slash YYYY
We realize that many campers use electronic games and music to relax and go to sleep at night. Because of this, we do allow campers to bring these electronic devices to camp. We do, however, have firm rules regulating the use of these devices. Please review these “no exception” rules with your camper.

a) ALLOWED DEVICES - iPod, iPad, handheld gaming devices, e-readers
b) Electronic Devices are collected by Staff after each use.
c) Electronic Devices are used in the cabin only.
d) There will be an electronic device schedule posted in each cabin.
e) Electronic device movies, TVs, Cellphones or Laptop computers are NOT allowed at camp.
f) Both camper and parent MUST sign below.

Parents, please understand that most campers do bring electronic devices to use during our relaxation time. While there are spots at camp where WiFi is available, campers are NOT ALLOWED to connect to this WiFi connection.

NOTE: Campers may bring a special toy, stuffed animal or other security item. However, please limit personal toys to what can be stored in a backpack. Campers are responsible for keeping track of their personal items.
Please type the camper's name to confirm that they have read and understand the electronics policy.*
Please type the parent/guardian name to confirm that you have read and understand the electronics policy.*
If you have your completed the Health/Physical Form, please upload here. If you are still waiting on a doctor appointment, this form can be submitted via e-mail or mail to camp@ausm.org or 2380 Wycliff St. #102, St. Paul MN 55114.
Max. file size: 20 MB.
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Save and Continue Later

Camp Discovery Packet

Camp Discovery Packet 2022

Step 1 of 5

Camper Information

Parent/Guardian Information

Additional Contact Information

Camping Experience Information

Medication/Health Information

Sleep Issues

General Camper Information

Camper School Information

Proactive Behavior Support Information

Address Book

Releases

True Friends

Photos

AUTISM SOCIETY OF MINNESOTA (AuSM) CAMPS CONSENT FORM FOR INFORMATION

AUTISM SOCIETY OF MINNESOTA (AuSM) WAIVER AND RELEASE OF LIABILITY AGREEMENT

AuSM Camp Policy Agreement