KESEM PARTICIPATION AGREEMENT
The following KESEM PARTICIPATION AGREEMENT is applicable to Kesem’s in-person camp and day programming, online/digital programming, Friends and Family Day, Year Round Support services and programming, Virtual Cabin Chats, and/or any other programming which occurs involving Kesem volunteers and constituents. Please read the following KESEM PARTICIPATION AGREEMENT carefully, including the Release of Liability and Assumption of Risk Agreements, which may deprive you of certain legal rights. By agreeing electronically, you acknowledge that you have reviewed, understand, and agree to all terms contained in the KESEM PARTICIPATION AGREEMENT.
This agreement includes:
PARTICIPATION AGREEMENT - IN-PERSON PROGRAMMING SPECIFIC ITEMS
Medical Treatment and Disclosure Authorization
Release of Liability and Assumption of Risk Agreement - In-person programming
Sleeping Arrangement Agreement
PARTICIPATION AGREEMENT - ONLINE/DIGITAL ITEMS
Release of Liability and Assumption of Risk Agreement - Online programming
Use of Third-party Software/Applications
PARTICIPATION AGREEMENT - ALL PROGRAM TYPES
Release of Liability and Assumption of Risk Agreement - Mental Health
Authorization for Information Release via Roster
Early Dismissal From Programming & Participation Eligibility
Kesem’s Equity & Inclusion Statement
Authorization of Verification of Information
PARTICIPATION AGREEMENT - IN-PERSON PROGRAMMING SPECIFIC ITEMS
In consideration of Kesem allowing my child to utilize the facilities and participate in the activities Kesem provides, I agree to the following:
I understand that Kesem may employ physicians, nurses, mental health professionals, and other persons whose services may be needed and/or utilized for my child’s healthcare or wellbeing while at Kesem (the “Health and Wellness Team”). I hereby authorize the following persons to provide for, approve, or authorize emergency medical care or psychiatric treatment for my child, including, but not limited to, medicines, immunizations, x-rays, tests, dental and minor surgical treatment, hospitalization, general anesthesia, risk assessments or any other treatment that is medically or mentally appropriate while my child is in the care of Kesem: the Health and Wellness Team; the Kesem Camp Advisor (the “Camp Advisor”); Kesem chapter leaders and volunteers; any member of Kesem’s National Staff, including Program Coordinators, Hotline Operators, Managers of Programs, the Director of Operations, the Kesem Chief Operating Officer, or the Chief Executive Officer (the “National Staff”); and/or any of those persons’ designees. I understand that the medical care I authorize may occur at any hospital, Urgent Care, emergency room, doctor’s office or other institution, including Kesem. I further understand that Kesem will always attempt to notify my child’s parent or guardian in case of emergency, but acknowledge that such attempts may be unsuccessful, and consent to the terms herein irrespective of whether my child’s parent or guardian is notified. I authorize any physician, nurse, or any other healthcare provider to communicate with any persons identified as my child’s emergency contacts (“Emergency Contacts”), as well as the Health and Wellness Team, Camp Advisor, chapter leader and volunteer, National Staff, and/or any of their designees about my child’s medical condition, treatment, and/or prognosis. I further authorize the Health and Wellness Team to discuss any of my child’s medical conditions with my child’s Emergency Contacts, the Camp Advisor, National Staff, and/or any of their designees to the extent that the Health and Wellness Team, in its sole discretion, determines that such communication is in the best interest of my child. I further authorize Kesem personnel to transport my child if deemed necessary by Kesem personnel. I understand that Kesem has absolute discretion to dismiss a child and that Kesem will not be responsible for any additional costs of transportation, food, or lodging. In the case of dismissal, my child can be picked up by myself or the emergency contact. I agree that these authorizations will remain in effect on all dates during which my child is registered to attend Kesem, or in attendance at any official Kesem event outside of the registration dates, including, but not limited to, Friends + Family Days, fundraisers, meetings, and trainings. I understand that if an early dismissal is warranted by Kesem volunteers and staff that I am responsible for ensuring my child is picked up within a reasonable timeframe of being notified.
I hereby give my permission for my child to attend all functions and activities Kesem provides during the dates my child is registered in programming. To the maximum extent allowed by law, I HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS KESEM, ITS PERSONNEL, ITS CO-SPONSORS, AGENTS, AND REPRESENTATIVES, FROM ANY AND ALL LIABILITY TO MY CHILD OR MYSELF, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, including, but not limited to, in connection with the following: transportation to and from programming; engagement of any and all activities during programming; consumption of all meals and snacks; contraction of any disease, virus, or infestation; the use of materials, buildings, and/or the environment; and the loss or destruction of personal property.
I also acknowledge that participation in Kesem programming may expose me to a risk of communicable disease that cannot be fully prevented. I acknowledge and understand that Kesem will NOT require COVID-19 testing or vaccination of participants or volunteers in order for them to participate in programming.
I acknowledge that participation in Kesem’s programming may involve exposure to activities, living accommodations, environmental exposures, foods, and personal interactions that may be new to my child. I acknowledge that my child’s participation in such activities may involve risks and uncertainties beyond those with which my child is familiar with at home, in previous years of camp/programming, or other camping experiences, including, but not limited to, exposure to uneven terrain, standing and moving water, and potentially dangerous plants and wildlife, including certain species of mammals, reptiles, and insects. I understand that my child may be exposed to communicable diseases even when actions are taken to prevent this from happening. I am also aware that my child may participate in off-campus activities, including overnight hikes and other nighttime activities, which may involve additional risks. In addition, I acknowledge that there are certain foreseeable and unforeseeable risks associated with various games and other activities, including, but not limited to, injuries caused by other participants or Kesem staff members, or by objects and equipment, such as balls and other projectiles.
I understand that no environment is risk-free, and I have instructed my child to abide by Kesem’s rules and to obey all instructions Kesem’s personnel may give, and my child and I both agree that he or she understands and will obey Kesem’s rules, including any and all health and safety rules/guidelines, and will comply with all instructions from Kesem personnel.
To the maximum extent allowed by law, I HEREBY ASSUME ALL SUCH RISKS, BOTH KNOWN AND UNKNOWN, ON BEHALF OF MY CHILD, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERS. I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY AGREEING TO IT, AND AGREE TO IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT, ASSURANCE, OR GUARANTEE BEING MADE TO ME AND INTEND MY AGREEMENT TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE MAXIMUM EXTENT ALLOWED BY LAW.
I acknowledge that, for overnight/residential programming, including camp programs, Kesem will utilize binary cabin options. Upon registration for the program, myself and my child(ren) will select the binary cabin option which best aligns with my child’s identity. I acknowledge that Kesem will only change a child's sleeping arrangement - regardless of which cabin they may move to or from - with explicit written permission of a parent/guardian. I acknowledge and accept that Kesem will assign my child’s sleeping arrangement based on age,registration status, and parent’s choice of cabin, and that they will share this space with other participants assigned in a similar manner. I acknowledge that I will not be notified of the cabin assignments of other participants, and that with parental permission cabin assignments may change while programming is occurring. I understand that there may also be gender non-conforming housing available and my child will only be housed there with my explicit written permission and based on availability.
2. PARTICIPATION AGREEMENT - ONLINE/DIGITAL ITEMS
In consideration of Kesem allowing my child to utilize the services and participate in the activities Kesem provides in anyonline/digital programming, I agree to the following:
I understand that Kesem employs certain individuals who may have training and/or certification in mental and behavioral health treatment and counseling. I acknowledge that to the extent that any Kesem personnel conduct discussions with my child relating to my child’s mental, behavioral, or emotional health, they are specifically not entering into a therapist-client relationship with my child, and that neither Kesem nor any of its agents, employees, or other personnel will provide counseling or any other mental health services to my child in an official capacity. Kesem staff members are considered mandated reporters of suspected child abuse and neglect, and are required by law to share any such information they learn of during any portion of online/digital programming. To the maximum extent allowed by law, I HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS Kesem, ITS PERSONNEL, ITS CO-SPONSORS, AGENTS, AND REPRESENTATIVES, FROM ANY AND ALL LIABILITY TO MY CHILD OR ME ARISING FROM ANY CONSULTATIONS OR OTHER DISCUSSIONS THEY MAY HAVE WITH MY CHILD, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE.
I understand that I am responsible for the safety of my home environment throughout my child’s participation in any Kesem online/digital programming. Virtual programming may include (but is not limited to) activities such as arts and crafts, dancing, song singing, watching movies, and group discussions. As the caregiver, I understand and acknowledge that I am responsible for maintaining a safe environment at home throughout my child’s participation in any Kesem online/digital programming.
I understand that I am responsible for my child’s health and safety throughout their participation in any Kesem online/digital programming. In-person, Kesem maintains rigorous safety protocols by trained staff and volunteers to ensure child’s safety at all times. These same safety protocols are not possible in a virtual/online format. I understand that, while Kesem is providing virtual programming for my child, it is not a replacement for childcare and supervision. I acknowledge that Kesem cannot maintain the same level of safety procedures, and that maintaining supervision of my child’s health and safety is my responsibility in-person.
I understand that personal identifying information (including email addresses, phone numbers, social media profiles, and any other identifying content) is not to be shared between my child and Kesem staff/volunteers. Kesem staff/volunteers understand that asking for or soliciting the collection of personal identifying information of any child is prohibited. I agree to ensure my child respects this privacy requirement, and does not engage in the exchange/sharing of any personal identifying information with Kesem staff/volunteers. In the event that personal identifying information is disclosed (such as if a phone number is displayed when calling in to a group call), Kesem will not distribute this information in any way except as required by applicable law.
I acknowledge that any Kesem online/digital programming is designed to help participants build community and connections with other participants who are like them and have shared experiences. These experiences are more effective and authentic when participants are able to connect with a group made up exclusively of their peers. For this reason, the only adults able to participate in Kesem’s online/digital programming are staff who have been selected, cleared a background check, and have completed required training provided by Kesem National. I acknowledge that the programming performed at Kesem’s online/digital programming is provided only for my enrolled child(ren). I understand that, by signing this agreement, I am providing my consent for only my registered child to participate in Kesem’s online/digital programming. I acknowledge that this is in the best interest of safety and privacy for both my child and all other participants.
I understand that any Kesem online/digital programming, may position myself, or other members of my household, in proximity of programming and conversations which otherwise we would not be privy to. This may result in inadvertently gaining private information about other participants and Kesem community members. I agree to respect privacy and keep confidential any such private information inadvertently gained through proximity during anyKesem online/digital programming. I further understand and agree that parents or other household members of other participants may similarly inadvertently gain private information about my child, and that they will have executed a similar agreement to respect privacy and keep confidential any such private information.
I hereby give my permission for my child to attend all functions and activities Kesem provides for Kesem’s online/digital programming. I understand that Kesem may facilitate programming for my child with mailed items, digitally/online, or on the phone and that other participants may be present during this programming. I understand and agree that outside companies hired by Kesem may mail items related to programming to the address provided in the program registration form. I understand that Kesem cannot control every conversation that may happen between my child and others, both during and after any Kesem online/digital programming. I understand that Kesem cannot control all risks associated with the mailing and receiving of items. To the maximum extent allowed by law, I HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS Kesem, ITS PERSONNEL, ITS CO-SPONSORS, AGENTS, AND REPRESENTATIVES, FROM ANY AND ALL LIABILITY TO MY CHILD OR MYSELF, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, including, but not limited to, conversations which occur between participants that are outside of the control of Kesem, and risks present with the mailing and receiving of items.
As a part of any Kesem online/digital programming, Kesem may engage participants using a variety of software platforms and applications. This includes, but is not limited to, Zoom video conferencing, Instagram, Facebook, and TikTok. While Kesem will take every reasonable measure to protect the privacy of their participants and families, Kesem cannot control the privacy and security measures of these third party applications. As the parent/caregiver, I understand that the decision to join any platform belongs to me and my child. I acknowledge that I am aware of and accept any risks associated with joining and using any of these applications/platforms, and I HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS Kesem, ITS PERSONNEL, ITS CO-SPONSORS, AGENTS, AND REPRESENTATIVES FROM ALL CLAIMS, DEMANDS, AND CAUSES OF ACTION THAT MY CHILD OR I MAY HAVE BY USE OF THESE PLATFORMS.
3. PARTICIPATION AGREEMENT - ALL PROGRAM TYPES
In consideration of Kesem allowing my child to utilize the services and participate in the activities Kesem provides in both in-person camp and online/digital programming, I agree to the following:
I understand that Kesem employs certain individuals who may have training and/or certification in mental and behavioral health treatment and counseling. I acknowledge that to the extent that any Kesem personnel consult or discussions with my child relating to my child’s mental, behavioral, or emotional health, they are specifically not entering into a therapist-client relationship with my child, and that neither Kesem nor any of its agents, employees, or other personnel will provide counseling or any other mental health services to my child in an official capacity. I agree to fully disclose any current and recent (within the past two years) mental health concerns I or my child’s doctors may have, including, but not limited to, thoughts or attempts of self harm, suicidal ideation or attempts, depression, and anxiety. I understand that if my child discloses thoughts or attempts of self-harm in any form, or Kesem personnel believe my child to be at risk of harming themselves or others, a shortened stay will be required for my child. If Kesem personnel are unable to reach me, I give Kesem permission to seek additional consultation or risk assessments from mental health or other medical professionals, and/or to contact Emergency Contacts to discuss details of the situation and organize an early departure for my child. To the maximum extent allowed by law, I HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS KESEM, ITS PERSONNEL, ITS CO-SPONSORS, AGENTS, AND REPRESENTATIVES, FROM ANY AND ALL LIABILITY TO MY CHILD OR ME ARISING FROM ANY CONSULTATIONS OR OTHER DISCUSSIONS THEY MAY HAVE WITH MY CHILD, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE.
I give my consent and permission to the Kesem chapter, Kesem National, and any other of their partners or affiliates to use or authorize the use of my child’s name and likeness, including photographs, videos, interviews, or other publicity-related items involving my child, for promotional, marketing, or any other uses. I further agree that I have no right, title, or interest in the materials described herein, and I authorize Kesem to reproduce and/or make derivative works from, as well as reasonable edits and alterations to, the materials. I waive any right to inspect or approve the finished product or materials in which Kesem, Kesem National, or any of its partners or affiliates may eventually use my child’s voice, image, and/or likeness. Further, I understand that, although Kesem will endeavor to use my child’s likeness in accordance with the standards of good judgment, Kesem cannot warrant or guarantee that any further dissemination of my child’s likeness will be under Kesem’s supervision or control. To the maximum extent allowed by law, I HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS Kesem, ITS PERSONNEL, ITS CO-SPONSORS, AGENTS, AND REPRESENTATIVES FROM ALL CLAIMS, DEMANDS, AND CAUSES OF ACTION THAT MY CHILD OR I MAY HAVE BY REASON OF THIS AUTHORIZATION. If, for any reason, I do not want any such items involving my child used in promotional, marketing, or other materials, I will notify Kesem in writing before my child’s first day of camp.
I give my consent and permission to Kesem, Kesem National, and any other of their partners or affiliates to distribute my contact information via a camp roster to other participants and families that attend Kesem. If, for any reason, I do not want my contact information to be distributed via a camp roster to other participants and families, I will notify Kesem in writing before my child’s first day of camp.
I agree that any dispute concerning, relating to, arising from, or referring to the subject matter of this Agreement or otherwise, shall be resolved exclusively by binding arbitration in the state and county where my child’s camp is located, according to the then-existing commercial rules of the American Arbitration Association and the substantive laws of that state, unless I and Kesem agree in writing to resolve the dispute in a different forum.
The arbitrator, and not any federal, state, or local court or agency, shall have exclusive authority to resolve any dispute relating to the interpretation, applicability, enforceability, conscionability, or formation of this Agreement, including, but not limited to, any claim that all or any part of this Agreement is void or voidable. If any provision of this Agreement or the application thereof to any person or circumstance shall, for any reason and to any extent, be invalid or unenforceable, the remainder of this Agreement and the application of that provision to other persons or circumstances shall not be affected, but rather shall be enforced to the maximum extent permitted by law. Each obligation or other provision of this Agreement shall be deemed and construed independently, and shall not be deemed to be dependent on any other provision of this Agreement.
Notwithstanding anything in this section 3(d) to the contrary, any arbitration shall be conducted between the disputing parties on an individual basis only. Under no circumstances shall any dispute be resolved on a collective or class-wide basis, and I hereby waive any right to have (or seek to have) any dispute concerning, relating to, arising from, or referring to the subject matter of this Agreement adjudicated or arbitrated on a collective or class-wide basis. Further, the arbitrator shall have no power either to certify a class or to issue any decision on a collective or class-wide basis. Should it be determined by a court or other applicable tribunal that the provisions of this paragraph are unenforceable, I agree that the provisions of this paragraph shall not be severed from the remainder of section 3(d) and instead that the entirety of section 3(d) shall be of no force or effect.
Rarely, we find that we need to dismiss participants from programming in situations where continued participation in programming may impact the safety of themselves or others. If your child needs to be dismissed from in-person programming, you (or an emergency contact designated on your child’s registration form) must come pick up the child. Please only provide Emergency Contacts who are available the entire duration of programming. If a child is dismissed and no one is able to pick them up, Kesem will attempt to work with you on a solution, however Kesem has the right to seek support from and/or transfer responsibility of the child to local child protective services, law enforcement, or a local hospital. If a child is dismissed from camp and no one is willing to pick up the child, Kesem has the right to seek support from and/or transfer responsibility of the child to local child protective services, law enforcement, or a local hospital.
Examples of situations in which your child may be dismissed from programming may include, but are not limited to, the following:
Physical illness or injury, particularly injuries or illnesses that are communicable (including potential or actual cases of COVID-19) or have a severe impact on the child’s participation in camp activities.
This includes lice and fevers that are present at check-in
Participants with a fever of 100.4 or higher during check-in will have to go home until the fever passes and remains gone for 24 consecutive hours without the use of fever-reducing medications. For programming of a shorter duration (such as a single day event, or Kesem Weekend), any participant with a fever over 100.4 will not be able to participate in the event, due to its shortened nature.
If a participant has a fever of 100.4 or higher for 24 hours or longer during programming they will have to go home until the fever passes. If this fever is accompanied by additional symptoms or concerns of COVID-19, the participant will have to go home for the remainder of the program.
Self-harm, suspicion of self-harm, or suicidal ideation - we are not equipped to monitor participants who are at risk of harming themselves.
Additionally, the following situations may result in an early dismissal from camp, digital/online programming, or any other Kesem programming:
Behavioral issues which fall outside of the scope and training of our counselors and staff, failure to comply with pre-programming behavioral plan, or behaviors that make others feel unsafe. NOTE: Kesem reserves the right to determine a child’s eligibility to continue participating in Kesem programming. Serious behavioral concerns, such as those listed below, may result in a dismissal from camp and loss of eligibility to participate in future years.
Kesem will use its discretion to determine if a dismissal from programming is necessary for:
Drugs or alcohol, including any tobacco product (vapes, e-cigarettes, etc.)
Threats to themselves or others - this includes running away
Harassment, including Sexual Harassment. A participant who engages in any harassment/sexual harassment may be ineligible to participate in future Kesem programs, including Kesem.
Harassment is defined as verbal, written, or physical conduct that belittles or defames an individual/group, shows hostility or aversion toward an individual/group, or creates an intimidating, hostile, unsafe, and/or offensive environment.
Sexual Harassment is defined as verbal, written, or physical conduct of a sexual nature that is unwelcome and offensive to others, and/or creates an intimidating, hostile, unsafe, and/or offensive environment.
Negative comments or jokes regarding one’s race, religion, sexual orientation, or gender identity
If these comments are made, Kesem volunteers and staff will discuss with the participant the consequences - this will result in a call home and if any additional comments are made, a shortened participation in programming
Kesem believes that connections form during Kesem programming in a more meaningful way when participants feel comfortable speaking openly with their Kesem staff. As a result, Kesem will maintain the confidentiality of discussions shared at camp/programming.
An exception to confidentiality is provided if your child poses a current threat of harm to themselves or to another person. In such cases, Kesem will take whatever steps are required by law, or permitted by law, to help prevent the potential harm from happening, including notifying the parent(s)/guardian(s), relevant child protective services, or medical professionals.
I understand that Kesem will notify me of any situations that may arise at camp/programming in which my child shares information that presents a current risk/danger to self or others.
I understand that my child may be in communication with or contacted by other Kesem participants throughout the year. I understand that Kesem is not responsible for the behavior of other Kesem participants and maintains no liability for the actions, conversations, or materials sent to my child. I understand that Kesem is not liable or responsible for any Kesem participants or volunteers who violate Kesem policies regarding post-camp communication.
By signing this agreement, the undersigned affirms that they agree to the terms and conditions of this agreement.
By signing this agreement, the undersigned attests that they are the parent or guardian of the participant and have full power and authority to enter this agreement on behalf of the participant.
By signing electronically below, the undersigned accepts and agrees to these terms on behalf of themselves and the participant, and agrees that this electronic version shall have the same force and effect as a written original.