Free Swimming and Surf Camp

StreetWaves Free Swimming and Surf Camp Application

Thanks for your interest in Streetwaves! Please fill out the form to join our student program.

June 16 - July 4 Delray Beach
July 7 - July 25th Deerfield Beach

*Please select the location and dates

June 16 - July 4 Delray Beach

July 7 - July 25th Deerfield Beach

*Which program are you applying for?

Free Summer Swim Camp (Monday to Friday 9 a.m. to 11 a.m.)

Free Summer Surf Camp (Monday to Friday 12 p.m. to 4 p.m.)

*Participant's First Name

*Participant's Last Name

*Participant's Date of Birth

*Participant's Cell Phone Number

*Parent/Legal Guardian Full Name

*Parent/Legal Guardian Email

*Parent/Legal Guardian Cell #

*Home Address

*Gender

Male

Female

Non Binary

Other

Preferred County of Participation

Miami-Dade

Broward

Palm Beach

Martin

*Does participant have experience swimming?

Beginner

Intermediate

Advanced

None

*Doe's participant have experience navigating ocean waters?

Yes

Does student have any allergies or special needs?

Yes

Does your child have food aversions, food allergies or dietary restrictions (Vegetarian, Kosher, etc.)? Please explain:

I consent to having StreetWaves Inc. and its partners and/or affiliates store my submitted information

Yes

AGREEMENTS POLICIES

✓ Surf Camp Campers will be supervised outdoors from their arrival at our daily location until 4:00 PM.

✓ After 4:15 PM, there will be no guaranteed supervision by StreetWaves staff.

✓ StreetWaves will not be responsible for students that are not picked up by 4:15 PM daily.

✓ If there is Inclement weather, lightning present, dangerous seas, or dangerous sea life StreetWaves will cancel for the day as a matter of safety precaution.

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PICK UP POLICY

Pick up will be promptly at 4:00 PM. If you would like to pick up your child early, please email (maui@streetwaves.org ) or text us at ( 305-901-9752) or (786-267-8448) prior to the day of early dismissal with the desired time of pick up. Parent/Guardian must sign out the student with our designated team leader. It is the responsibility of the parent to understand the pickup location for each day.

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DISCIPLINE POLICY

The purpose of a discipline policy is to facilitate a positive climate where each student feels safe and secure. The StreetWaves student code of conduct is RESPECT, KINDNESS & COMMUNICATION to achieve a peaceful and positive environment that fosters effective teamwork. We are a bully-free zone and actively educate participants on anti-bullying tools and techniques. Campers will be provided with opportunities to grow in personal and social development and, if they are involved in a discipline concern, are given due process. If there is continued reason for concern, the camper, parent and team leader will have a team meeting to assess how to productively manage the concern. If it cannot be resolved quickly the camper will be excused from the program.

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PHOTO/VIDEO CONSENT

Our program will be documenting our success throughout the year and we therefore ask for parent/guardian consent to the recording of statements, photographs, and/or audio or video recordings taken of camp participants. All statements, photographs, and/or audio or video recordings taken of student participants, by StreetWaves or our contracted media partners. StreetWaves or our media partners may use for promotional, commercial, training or other purposes as determined by StreetWaves or media partner in its sole discretion.

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PROGRAM GUIDELINES

StreetWaves does not discriminate because of race, color, religion, orientation, gender, national origin, physical or mental disability. We operate in a mobile device-free zone. Cell phones are not allowed to be used while they are in the water. Should you need to contact a participant during program hours please contact us directly by calling/texting 305-901-9752. Participants are responsible for bringing their own swimsuit, towel, change of clothes and any additional swim aids or accessories that person may desire. Please initial below

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EMERGENCY CARE

StreetWaves requires parent/guardian permission for StreetWaves to arrange emergency care for a child participant. A parent/guardian will be contacted first and in the event they cannot be reached immediately in an emergency care situation, then a designated emergency contact will be notified. If parent/legal guardian or any other emergency contact person cannot be reached parent/legal guardian gives permission to StreetWaves to arrange emergency care for participating child. Parent/Legal Guardian authorizes the StreetWaves team to use the closest medical facility and grant permission for the medical facility to provide medical care. Please initial below

Please initial below

*I agree to the terms of the "POLICIES" listed above by StreetWaves.

I agree

I disagree

*WAIVER: I UNDERSTAND THAT SWIMMING, SURFING AND RELATED ACTIVITIES TO BE CONDUCTED UNDER THIS CONTRACT HAVE INHERENT RISKS WHICH INCLUDE, BUT ARE NOT LIMITED TO, FALLING, INJURING YOURSELF AND OTHERS AND EVEN DEATH BY DROWNING, BLEEDING OR ATTACK BY SHARK OR OTHER SEA CREATURES AND STREETWAVES, INC, ITS AGENTS, SUCCESSORS OR ASSIGNS WILL NOT BE HELD RESPONSIBLE FOR SUCH. I ACKNOWLEDGE AND DECLARE THAT I CAN SWIM SUFFICIENTLY WELL TO UNDERTAKE THE ACTIVITIES TO BE CONDUCTED UNDER THIS CONTRACT AND I AM NOT AWARE OF ANY PHYSICAL, EMOTIONAL OR MENTAL CONDITION THAT WOULD OR MIGHT PUT ME OR ANYONE ELSE AT RISK THROUGH THE ACTIVITIES TO BE CONDUCTED UNDER THIS CONTRACT. I WILL USE ALL OF THE EQUIPMENT AT MY OWN RISK. I WAIVE ANY CLAIM WHATSOEVER AGAINST STREETWAVES, INC, ITS AGENTS, SUCCESSORS OR ASSIGNS RELATED TO MY USE OR POSSESSION OF RENTAL PROPERTY. I AGREE TO INDEMNIFY AND HOLD HARMLESS STREETWAVES INC, ITS AGENTS, SUCCESSORS AND ASSIGNS FOR ALL INJURIES AND ACCIDENTS, OR OTHER CLAIMS, INCLUDING ATTORNEY FEES AND COSTS ARISING FROM OR CONNECTED TO THE RENTAL PROPERTY OR LESSONS. STREETWAVES, INC. DOES NOT WARRANT OR GUARANTEE THE RENTAL PROPERTY IN ANY FASHION NOR FOR ANY PARTICULAR USE OR PURPOSE. I WILL PAY ALL ATTORNEY FEES AND COSTS INCURRED IF ANY SUIT OR CLAIM IS BROUGHT AGAINST STREETWAVES INC, OR ITS AGENTS, SUCCESSORS OR ASSIGNS RELATED TO THIS CONTRACT. THE LAWS OF THE STATE OF FLORIDA GOVERN THIS CONTRACT. ANY SUIT OR CLAIM ARISING FROM THIS CONTRACT SHALL BE BROUGHT AND MAINTAINED IN MIAMI - DADE COUNTY, FLORIDA. I WAIVE THE RIGHT TO A JURY TRIAL IN ANY SUIT ARISING FROM OR IN CONNECTION WITH THE CONTRACT AND SUBMIT TO THE PERSONAL JURISDICTION OF THE COURTS OF MIAMI - DADE, BROWARD OR PALM BEACH COUNTY, FLORIDA. THIS CONTRACT SHALL BE BINDING UPON ALL PARTIES, THEIR HEIRS, SUCCESSORS AND ASSIGNS. WAIVER AGREEMENT:

I agree

I disagree

VIDEO CONSENT AND RELEASE

Effective as of the date of this application, approval for past use and permission for present and future use is being granted to StreetWaves Inc. to use a picture or video/voice recording of participating student. Permission is being given by the undersigned parent/guardian of minor participants, (the "Recorded Party"), as explained in this Consent and Release. The undersigned is an adult and fully authorized to sign this Consent and Release. For a valuable consideration, receipt of which is hereby acknowledged, the undersigned hereby grants to StreetWaves Inc (info@streetwaves.org) and its agents, employees, licensees, and successors in interest (collectively, the "Released Party") all ownership rights and the absolute and irrevocable right and permission to copyright, use and publish the recorded image and/or voice of participating minor student (the "Image and/or Voice") that has been (or is being) obtained pursuant to this Consent and Release. The Image and/or Voice may be copyrighted, used and/or published individually or in conjunction with other photography, video works, and recordings, and in any medium (including without limitation, print publications, public broadcast, CD-ROM format) and for any lawful purpose, including without limitation, trade, exhibition, illustration, promotion, publicity, advertising and electronic publication. The undersigned represents and warrants that (i) no other party has been granted an exclusive license with respect to the Image and/or Voice, and (ii) no other party's authorization or consent is required with respect to the permission granted to the Released Party under this Consent and Release. The undersigned waives any right that the undersigned may have to inspect or approve the Released Party's use of the Image and/or Voice, or the advertising copy or printed matter that may be used in connection with the use and/or publication of the Image and/or Voice. The undersigned releases the Released Party (and all persons acting under its permission or authority) from all claims for libel, slander, invasion of privacy, infringement of copyright or right of publicity, or any other claim related to the Image and/or Voice (collectively, "Claims"). This release includes without limitation any Claims related to blurring, distortion, alteration, optical illusion, digital alteration, use in composite form, whether intentional or otherwise, or use of a fictitious name, that may occur or be produced in the processing or publication of the Image and/or Voice. The undersigned warrants that the undersigned has read this consent and release prior to the signing of this document that the undersigned understands it, and that the undersigned freely enters into this consent and release. "VIDEO CONSENT & RELEASE" AGREEMENT

I agree

I disagree

Signature (Parent/Legal Guardian) * I have read and understood the StreetWaves After School Aquatics Enrichment Agreements and I understand and acknowledge the policies, waivers, consents and releases. Signature: Type your name to sign

StreetWaves Free Swimming and Surf Camp Application

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