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1 Summer!MPACT provides a balance of structure and choice activities for middleschoolers who want to have an unforgettable summer! Each week campers are offered three exciting fieldtrip opportunities as well as many other specialized activities led by our exceptionally qualified staff. Fieldtrips Tournaments Crafts Sports Cook-offs Video Games Humans vs. Zombies Secret Missions Maywood M.S. Serving all incoming 6th, 7th, & 8th graders living within Issaquah School District boundaries JUNE 20 AUGUST 17 7:00 AM 6:30 PM REGISTER ONLINE March 21 April 18 $50 per day Register Online:
2 Monday Tuesday Wednesday Thursday Friday Important Reminders! WEEK 1: Hours of Operation: WEEK 2: 27 ipad Scavenger Hunt DIY Piñatas Dodgeball Tourney Summer Skyline HS Magician, Hypnotist, Improv 28 Finding Dory North Bend Theatre 29Wilderness Wed. Life Size Clue Sardines THE ROOM Pajama Day 30 Art Day Round One Bowling & Video Games 1 7:00 AM 6:30 PM $3 per minute per child late fee if child is present past 6:30 PM *Please remember to bring your ID upon pick up. WEEK 3: 4 WEEK 4: Laser Quest CLOSED Independence Day 11 Game Day Murder Mystery Uncles Games MTG Draft 5 Wild Waves 12 CLOSED Vasa Park 6 Geocaching Gutter Garden Werewolves in the Woods Apps in Real Life Temple Run Fruit Ninja Angry Birds 13 Game Show Day Family Fued Jeopardy Cowboy/Cowgirl 7 Still Life Painting Mudhouse Pottery Bleach T-Shirts Whirly Ball and Alderwood Mall 14 Mox Boarding House Humans vs. PLMS American Zombie 8 Secret Life of Pets AMC Woodinville Animal Day 15 King County Fair Bring a lunch with a drink everyday unless otherwise indicated. Lunch is provided on indicated days. Fieldtrips will depart at 9:30 AM and return by 4:00 PM unless otherwise indicated. WEEK 5: WEEK 6: Minecraft Day 3D Perler Designs Dirt Baking Mob Paper Craft Minecraft Build Humans vs. Zombies with 5th Graders WEEK 7: 1 DIY Day 19 Wild Waves 26 2 Tillicum Village 20 Mariners vs. White Sox Mariners Gear 27 3 Casino BLMS 21 Stone Gardens & Crossroads Mall 28 Experience Music Project & Seattle Center 4 22 Animal Day Animal Encounters Paper Craft Pets Henna 29 Street Art Day T-Shirt Design Spray Paint Stencils Halloween in July 5 Healthy Living Day Blue: On-Site Activities Pink: Field Trips Purple: On-Site Enrichment Orange: Spirit Days Underlined: Requires an Additional Permission Form see the website for more details WEEK 8: WEEK 9: 15 Ballin with Bair One Day Movie Challenge 8 Science Day Mr. Science Sub Zero Ice Cream Soap Making Water Battle Balloon Launch 9 Woodland Park Zoo Sprinker Recreation Center 16 Pancake Art Cooking with Jill Kahoot Trivia Wild Waves 10 Lynnwood Bowl & Skate *socks Way Back Wed. 17 Giant Games Giant Bubbles Ballin with Bair IMPACT MMS Sports Day 11 Vasa Beach Park Bouncy Houses CLOSED for School Year Prep 12 DIY Smoothie Parkour Yoga Best of Summer Gym Crafts Cooking CLOSED for School Year Prep No Refunds Dates registered for are the dates services will be provided. There will be no switching or adding days after registration is closed. Fees will not be prorated for absences, special events or vacations. There will be no drop-in services. Parents are responsible for payment based upon the days registered, regardless of attendance. A $20.00 per day credit will be applied to your account if parents submit withdrawal requests by June 3, Maywood M.S th Ave SE Renton, WA Sign In/Out: Portable 2 Site (425) Cell (425) *Cell is only used in emergencies and on field trips
3 2029F Instruction Student Animal Permission Form 3/21/16 A variety of petting zoo animals will be on School District property for an educational purpose on the date specified on the summer camp calendar for the site which I registered my child(ren). I give my permission for my student to be in the same environment as the animal and/or to interact with the animal. I will alert the principal or staff member overseeing the event if I have concerns about the animal posing an allergy, health, or comfort issue for my student. Site: Child s Name: Parent Signature: Date: Please return this form by (Monday, June 20th) to the Site Coordinator
4 Stone Gardens, Inc. THE CLIMBERS GYM Assumption of Risks, Release of Liability, Covenant Not to Sue, Waiver of Claims, and Indemnity Agreement ( Agreement ) PARTICIPANT INFORMATION: FIRST NAME LAST NAME MIDDLE NAME DATE OF BIRTH ADDRESS CITY STATE ZIP CODE HOME PHONE WORK PHONE CELL PHONE Y / N MAY WE YOU? EMERGENCY CONTACT READ CAREFULLY BEFORE SIGNING! EMERGENCY PHONE In consideration of being allowed to participate in any way in the climbing activities of or sponsored by Stone Gardens, Inc. ( Stone Gardens ), whether such climbing activities occur at a Stone Gardens Facility or elsewhere, I, [please print], the Participant identified above or if the Participant is a minor, the Participant s Parent, acknowledge, appreciate and agree as follows. For purposes of this Agreement: climbing activities include without limitation bouldering, climbing, belaying and rappelling, using auto-belays, any related practice, training or team building activities (such as slack-lining), physical fitness training and recreational games, and anything incidental or related to any of the foregoing including transportation to, accessing and using any related facilities in any way; Parent means the Participant s parent or court-appointed legal guardian; and I, me, myself, my and any other first person references include both the Parent and the minor unless the context otherwise requires: 1. Assumption of Risks. (a) I fully understand that this Agreement describes some but not all of the risks, hazards, dangers and potential consequences of the climbing activities, which include: (i) Participants must make judgments and decisions as they participate in climbing activities and Stone Gardens staff must make judgments and decisions as they instruct or assist participants regarding climbing activities. These judgments and decisions are by their nature imprecise and subject to error. Judgments and decisions will be made in an environment that includes some routes that are designed to be challenging even to very capable and experienced climbers. Among other risks there is the risk that the Participant or a staff member may misjudge the Participant's abilities or fitness level; (ii) equipment (including, without limitation, artificial climbing walls, holds and anchor points, ropes, slings, harnesses, climbing shoes and climbing hardware whether the Participant's personal equipment or equipment rented or borrowed from Stone Gardens) may break, malfunction or be misused. Stone Gardens makes no warranties regarding any such equipment; and (iii) the Participant or others may act carelessly or recklessly or generally fail to exercise care. For example: By failing to clip into the auto-belay device before climbing, clipping the auto-belay device into the wrong part of the harness or into something other than a real harness. These and other risks, hazards and dangers may result in the Participant falling to the floor or ground, becoming entangled in ropes or other equipment or hitting artificial climbing walls, holds, anchor points or other objects or people. These and other circumstances may cause fractures, sprains, broken bones, concussions, cuts or abrasions, or other injury or illness, mental or emotional trauma, paralysis, disability or death. (b) I also fully understand that any instruction, training, orientation or other information or assistance provided by Stone Gardens cannot eliminate such risks. In both supervised and unsupervised climbing activities, I acknowledge that I am responsible for my own safety and if I am a Parent, the safety of the Participant. (c) Therefore, I knowingly and voluntarily assume all risks, both known and unknown, relating to the climbing activities and I accept full responsibility for those risks identified here and for those risks not identified and for injury, damage, death or other loss suffered by me and, if I am a Parent, by the Participant, resulting from those risks or resulting from my own negligence or other conduct. stonegardens.com
5 Stone Gardens, Inc. THE CLIMBERS GYM page 2 2. Release of Liability, Covenant Not to Sue, Waiver of Claims, and Indemnity. For myself and on behalf of my heirs, executors, assigns, personal representatives and next of kin (and, if I am a Parent, also on behalf of my child or ward), (a) I agree to release and I covenant not to sue Stone Gardens, its officers, agents, employees, volunteers, representatives, other participants, sponsoring agencies, sponsors, advertisers and if applicable, owners and lessors of premises used for the climbing activities (all collectively, the "releasees"), with respect to any and all claims, liabilities, suits and expenses (including attorneys fees and costs) (all collectively, "Claims"), arising out of any injury, damage, death or other loss in any way connected with my participation in the climbing activities or use of Stone Gardens equipment and facilities. I understand that I agree here to waive all claims I may have against Stone Gardens and the other releasees and agree that neither I nor anyone acting on my behalf will make a claim or file a lawsuit of any kind against Stone Gardens or the other releasees as a result of any injury, damage, death or other loss; and (b) I agree to indemnify, protect, defend and hold harmless the releasees with respect to all Claims (i) brought by me or on my behalf arising out of any injury, damage, death or other loss in any way connected with my participation in the climbing activities or use of Stone Gardens equipment and facilities; (ii) brought by a co-participant or any other person, arising out of any injury, damage, death or other loss claimed to be caused in whole or in part by my conduct in the course of participating in the climbing activities or using Stone Gardens equipment and facilities; (iii) brought by or on behalf of any family member or minor accompanying me; or (iv) arising out of any breach by me of this Agreement. This release, covenant not to sue, waiver and indemnity includes any Claims caused in whole or in part by the negligence of Stone Gardens or any of the other releasees (but not gross negligence or reckless misconduct) and includes claims for personal injury, property damage, wrongful death, products liability, breach of contract or otherwise. 3. Representations, Warranties and Agreements. I represent, warrant and agree that: (a) My participation in the climbing activities is purely voluntary, and I choose to participate regardless of and with knowledge of the risks; (b) I will comply with all rules and regulations of Stone Gardens and the stated and customary terms and conditions for participation in the climbing activities; (c) I acknowledge that participating in the climbing activities requires a special degree of skill and knowledge different from other activities and that I have responsibilities as a participant. I have no mental or physical problems or limitations that might compromise or affect my ability to participate in the climbing activities or to comply with my responsibilities in connection therewith. I represent that I am fully capable of participating in the climbing activities without causing harm to me or others. I acknowledge that Stone Gardens staff is, and have been available, should I have further questions about the nature and physical demands of the climbing activities and the risks, hazards and dangers associated with the climbing activities. If I observe any unusual significant hazard during my participation, I will remove myself from participation and immediately bring such hazard to the attention of Stone Gardens. 4. Transportation and Medical Care. Staff of Stone Gardens is authorized to obtain or provide medical care for Participant or to transport Participant to a medical facility. Medical personnel are authorized to render such treatment as they deem necessary for Participant's health. Stone Gardens has no responsibility for medical care provided to Participant and I agree to pay all costs associated with such medical care and transportation. 5. Governing Law; Forum. This Agreement is governed by the laws of the State of Washington. Further, any proceeding arising out of or relating to Participant's participation in the climbing activities must be filed or entered into only in the State of Washington. 6. Severability. Any portion of this Agreement deemed unlawful or unenforceable shall not affect the enforceability of the remaining provisions of this Agreement and the remaining provisions shall continue in full force and effect. 7. Effectiveness. This Agreement (i) shall be effective when signed either by Participant or (if applicable) by Participant's Parent, or both, (ii) shall be valid and binding until it is cancelled or modified by written agreement and (iii) shall cancel any prior Assumption of Risks, Release of Liability and Indemnity Agreement or prior similar agreement or waiver signed by Participant or (if applicable) by Participant's Parent in favor of Stone Gardens (except any under which there is any claim or basis for any claim). stonegardens.com
6 Stone Gardens, Inc. THE CLIMBERS GYM page 3 8. Mediation; Binding Arbitration. I agree to attempt to settle any dispute (that cannot be settled by discussion) through mediation before a mutually acceptable mediator. Any claim or dispute of whatever nature, including but not limited to the issue of arbitrability, arising out of or relating to this Agreement and that is not resolved through mediation shall be resolved by final and binding arbitration administered by the American Arbitration Association ( AAA ) in Seattle, Washington in accordance with the AAA commercial arbitration rules and judgment upon the award may be entered in any court having jurisdiction over the matter. NOTICE OF ARBITRATION AGREEMENT: This Agreement provides that all disputes between you and Stone Gardens will be resolved by binding arbitration. You thus give up your right to go to court to assert or defend your rights under this Agreement. Your rights will be determined by a neutral arbitrator and not a judge or jury. For more information regarding arbitration, please go to I HAVE CAREFULLY READ THIS AGREEMENT, FULLY UNDERSTAND ITS TERMS AND UNDERSTAND THAT BY SIGNING IT FREELY AND VOLUNTARILY I HAVE GIVEN UP SUBSTANTIAL RIGHTS, INCLUDING WITHOUT LIMITA- TION THE RIGHT TO SUE STONE GARDENS OR ANY OF THE RELEASEES FOR CLAIMS ARISING OUT OF ANY INJURY, DAMAGE, DEATH OR OTHER LOSS RELATING TO CLIMBING ACTIVITIES. Signature of Participant (18 years and older must sign) Participant Name Date PARENT/COURT-APPOINTED LEGAL GUARDIAN OF MINORS (UNDER AGE 18 AT TIME OF REGISTRATION) As the parent or court-appointed legal guardian with legal responsibility for the Participant I consent and agree to the Participant s assumption of risks, release of liability, covenant not to sue, waiver of claims and indemnity as provided in this Agreement. For myself, my heirs, executors, assigns, personal representatives and next of kin I release and covenant not to sue, waive and agree to indemnify, protect, defend and hold harmless the releasees from any and all Claims relating to the Participant s participation in climbing activities in accordance with the terms of this Agreement. Signature of Parent(s) (or Court-Appointed Legal Guardian) Parent/Guardian Name Date stonegardens.com
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