Kids Summer Camp: Kids Culinary Camp is a unique rural Vermont summer camp experience for campers ages 7 and older. Kids who enjoy cooking will eat this summer camp up!

2009 Season Camp Enrollment Form


Instructions: This is a 2 step process. This form must be fully completed and submitted by clicking the "SUBMIT" button at the bottom of this form. Step 2 is the initial payment with registration which may be done electronically by clicking the applicable "PAY NOW" button on the Registration Page.

Camper's Information
* Name:
* Address:
* City:		*State:
* Zip:
Email:
* Home Phone:		Cell:
* Date of Birth:
Gender:	M F
Grade Level: ( 06/07 school year )
Desired Session:
Reservation Type:	Day Camp Residential Camp

1 week session $2650.00 2 week session $4900.00 Each additional week $2000.00 Day Camp Tuition: 1 week session $1275.00 2 week session $2100.00 Each additional week $800.00

Please describe any Food Allergies or Religious Food Restrictions:

Please describe any Behavioral or Medical Conditions or Medications taken or Handicaps:

* Physician's Name:
* Physician's Phone Number:

T-Shirt Size ( Adult Sizes Only - Check One )		XS S M L XL
Will this be his/her first overnight camp?
Will (s)he be attending our camp with any other friends or relatives? If yes, whom?

Contact Parent's Information
* Name:
* Address:
* City:		* State:
* Zip:
Occupation:
* Home Email:
Work Email:
* Home Phone:		Cell:
Work Phone:

Other Parent or Emergency Contact
* Name:
* Address:
* City:		* State:
* Zip:
* Relationship to Camper:
Occupation:
* Home Email:
Work Email:
* Home Phone:		Cell:
Work Phone:

Please read the following Parent/Guardian Authorization: Scroll using the scroll bar on the right. A hard copy of this document will be sent to you electronically for acknowledgement following your on-line registration. Thank you.
I hereby certify that I am a parent or guardian with legal c ustody of the above named Camper and that he/she has my permission to engage in all of The Kid's Culinary Academy of Vermont instruction, trips and activities, including but not limited to, use of kitchen utensils and knives; food handling; kitchen cleaning, food preparation, cooking and baking; boating; swimming; aquaponics; beekeeping; general gardening; touring of and travel to and from factories, exhibitions and farms; camping; hay rides; and campfire and outdoor cooking activities. I hereby give permission to staff, employees and agents of The Kid's Culinary Academy of Vermont to provide routine health care, administer prescribed medications, and seek emergency medical treatment, including, but not limited to ordering x-rays or routine tests. I agree to the release of any records necessary for insurance or other medical purposes. I give permission to The Kid's Culinary Academy of Vermont to arrange necessary related transportation to my Camper with respect to any and all of the foregoing. In the event that I cannot be reached in an emergency, I hereby give permission to the physician selected by The Kid's Culinary Academy of Vermont to secure and administer treatment(s), including hospitalization, for the Camper named above. This completed form may be photocopied for trips off theCamp premises or for other reasonably necessary purposes. I, the undersigned, hereby grant permission to The Kid's Culinary Academy, its/their agents, successors, assigns, field producers and/or representatives to photograph/record//video my Camper and to record his/her voice, performances, poses, acts, plays and appearances, and use his/her picture, photograph, silhouette and other reproductions of his/her physical likeness and sound for The Kid's Culinary Academy purposes and the unlimited distribution, advertising, promotion, assignment, exhibition and exploitation of the Pictures by any method or device now known or hereafter devised in which the same may be used, and/or incorporated and/or exhibited and/or exploited. I agree that I will not assert or maintain against you, your successors, employees, investors, managers, agents, assigns and licensees, any claim, action suit or demand of any kind of nature whatsoever, including but not limited to, those grounded upon invasion of privacy, rights of publicity or other civil rights, or for any other reason in connection with your use of my physical likeness and sound as herein provided in any production(s) whatsoever. I hereby release you, your successors, agents, employees, investors, managers, assigns and licensees from causes of action(s), costs and expenses whatsoever, at law or in equity, known or unknown, anticipated or unanticipated, which I ever had, now have, or may, shall or hereafter have by reason, matter, cause or thing arising out of your use as herein provided. I affirm that neither I, nor anyone acting for me, gave or agreed to give anything of value to any of your employees, agents or any representative of any televised station, network or production entity for arranging my Camper's appearance on the Pictures. I have read the foregoing and fully understand the meaning and effect thereof and, intending to be legally bound, I have signed this release. I represent that I am the parent/guardian of the minor Camper named above and further I agree that the grant and release contained herein binds me and said minor Camper to all of the terms thereof. I have enrolled the above named Camper in one or more of the weekly sessions (collectively the "Session(s)") of The Kid's Culinary Academy. I understand the above named Camper's participation in The Kid's Culinary Academy Session(s) involves exposure to inherent risks that cannot be eliminated. I also understand that my Camper's participation in the Session(s) may require the use of knives, forks and spoons and kitchen equipment, food and food handling equipment, and boats and boating equipment, gardening equipment, outdoor cooking equipment and other similar tools and instructional and recreational gear which have the potential risk of injury. Individually, and as the parent or guardian of the Camper, I HEREBY EXPRESSLY ASSUME ALL RISKS associated with the Camper's participation in the Session(s) including all risks associated with the above and any and all other of The Kid's Culinary Academy of Vermont activities. Despite my understanding of the foregoing risks, I, individually and as the parent or legal guardian of the Camper, AGREE NOT TO SUE AND TO RELEASE FROM LIABILITY AND TO DEFEND, INDEMNIFY AND HOLD HARMLESS THE KID'S CULINARY ACADEMY OF VERMONT, and their representatives, owners, employees and agents for any damage or injury arising out of the Camper's participation in the Session(s) regardless of the cause, including NEGLIGENCE. I understand that the foregoing is a LIABILITY RELEASE and a MEDICAL AUTHORIZATION that is legally binding on me, the Camper, our heirs, assigns and our legal representatives, and further that II sign/submit it of my own free will. I acknowledge on behalf of myself and the Camper that the foregoing is binding and of legal effect during the entire 2008 summer camp season and in perpetuity. By clicking the button below, I certify that I am the individual described in paragraph B above and agree to all of the foregoing in perpetuity.

Please review all information carefully before clicking on the enrollment button below.

Created by George C. Jobel