Personal Information
First and last name of the participant
GHH CAMP CODE OF CONDUCT GUIDELINES
Behavior Guidelines
Campers shall be responsible for their words and actions.
Campers shall be respectful of others.
Campers shall follow directions from Staff Members, Camp Counselors and Volunteers.
Campers are not to allow cell phones or other electronic devices to disrupt ongoing activities.
Campers are not allowed to leave the premises without permission.
Prohibited Behaviors
Endangering the health and safety of themselves, other campers, and/or staff or volunteers.
Stealing, damaging, or failing to care for the Center or personal property.
No disruptive behavior on any of the transportation vehicles or failure to comply with the drivers’ safety instructions.
Refusal to follow the behavior guidelines or inappropriate physical contact.
Using profanity or inappropriate language or displaying clothing with offensive content.
Continual disruption of the program. Bullying or acts of aggression or violence.
Possession or use of illegal substances, tobacco, or alcohol.
Possession of weapons - any object that may cause harm to another.
Steps taken for failure to follow the behavior guidelines
Counselors will redirect the camper to a more appropriate behavior.
The camper will be reminded of the behavior guidelines.
If the behavior persists, staff will discuss the problem with a parent/guardian.
The staff will document the situation. The written documents will include what the behavior problem is, what provoked the problem, and the corrective action taken.
If the problem persists to the point where a second phone call becomes necessary, The Camp Director mayfind it necessary to have the camper picked up early from camp.
If a camper's behavior at any time threatens the safety of him/her, other campers, or staff, the parent/guardian will be notified and expected to pick-up the child immediately.
*I have read and explained all of the information provided in this document to my child. If any of the actions listed are violated by my child, it is understood that immediate dismissal from the program is expected.
I,
of
Dated
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FOSTERING NEW BEGINNING
Genesis Hopeful Haven Allergen Release Form
WAIVER AND RELEASE OF LIABILITY - Each person attending any GHH Camp or Activity, must complete a Liability Waiver & Release form
I (participant or guardian),
fully understand and acknowledge
that meals and snacks will be provided each day of camp.
ALLERGY AWARENESS NOTIFICATION: If you or minor participant have food allergies, please be aware that Genesis Hopeful Have does not guarantee an allergen-free environment. Recipes may contain peanuts, nuts, nut oils, egg, shellfish, dairy, gluten, soy, produce and other food allergens.
Please sign and print your name below if you are 18 years and older to release liability.
Signature:
Printed Name:
Date:
If the participant is a minor or not their own guardian, parent or guardian must sign below.
I hereby certify that I am the parent or guardian of the above -mentioned individual and I give consent without reservations to the foregoing contract on behalf of him or her and release liability.
Participant minor’s full name:
Parent/Guardian Full Name (Printed):
Parent/Guardian Signature:
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COVID Assumption of Risk, Release, and Waiver of Liability PARTICIPANT Agreement
RELEASE AND WAIVER. In consideration of my receiving services from Genesis Hopeful Haven I, being 18 years of age or older, or the guardian of a youth under the age of 18 do hereby forever release, waive, discharge, and covenant not to sue and its past, current, and future officers, directors, employees, members, volunteers, contractors, representatives, parents, owners, affiliates, agents, successors, and assigns GHH from any and all damages, injuries, losses, liability, claims, causes of action, litigation, or demands, including but not limited to those for personal injury, sickness, or death, as well as property damages and expenses, of any nature whatsoever which may be incurred, directly or indirectly, now or in the future, in any way related to COVID-19 and in connection with my participation in the Services or any travel related thereto. I promise not to sue GHH for any of the foregoing. ASSUMPTION OF RISKS. I understand that while GHH has undertaken reasonable steps to lessen the risk of transmission of COVID-19 in connection with the Services, GHH is not responsible in any manner for any risks related to COVID-19 in connection with the Services. Furthermore, I represent and warrant that I or participating youth do not suffer from any medical condition or disease that might in any way hinder or prevent me from receiving the Services, including, to my knowledge, COVID-19. This Agreement contains the entire understanding of the parties relating to the subject matter, and shall not be altered, modified, amended, waived or supplemented in any manner whatsoever except by a written agreement signed by both parties here to or their duly authorized representatives.
I have read and understood this Agreement and entered into it voluntarily in consideration of the opportunity to participate in the Services provided by Genesis Hopeful Haven.
Print name of participating youth
Print name of participant age 18 or over
Is youth partially or fully vaccinated -
/ if partially when is second shot due
Signature of Parent/Guardian/Caregiver
Signature of participant age 18 or over
Are you partially or fully vaccinated -
/ if partially when is 2nd shot due
Date this document was signed
Officer of Genesis Hopeful Haven
Parent/Guardian and Participant Release Statement
If my child has medical conditions, which may be relevant to a physician in the event of an emergency, I have listed them below. In the event an emergency occurs, I may be reached at the telephone number listed below.If I cannot be reached, I hereby authorize
to make a decision on my behalf.If there are any activities I do not
want my child to be involved in, I have listed them below. I understand and hereby agree to assume all of the risks, which may be encountered on said activity, including activities preliminary and subsequent thereto.
I do hereby agree to hold Genesis Hopeful Haven, and its agents employees, harmless from any and all liability, actions, causes of actions, claims, expenses, and damages on account of injury to my child or property, even injury resulting in death, which I now have or which may arises in the future in connection with the activity or participation in any other associated activities. I expressly agree that this release, waiver, and indemnity agreement is intended to be broad and inclusive as permitted by the State of Florida and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. This release contains the entire agreement between the parties hereto and the terms of this release are contractual and not a mere recital.
I further state that I have carefully read the foregoing student information and behavior code, the parent/guardian and participant release and know the contents thereof and I sign this agreement and release as my own free act. This is a legally binding agreement which I have read and understand.
Participant’s Name (Printed):
Parent/ Guardian’s Signature:
Parent/Guardian Name (Printed):
Emergency Contact:
Cell:
Please list the activities you do not want your child to participate in:
ADULT SIGNATURE:
If your child breaks property, legal guardian will be responsible for paying for damages.
(To be signed by guardian):
I, the Undersigned Parent/Guardian, Hereby Consent To My Child
destroys property then I will pay for any property damages.
Date received and filed by GHH:
Phone number: 786-227-6704
SUPERVISOR SIGNATURE:
GHH Visitor & PickUp Permission Authorization
Please note that only the enrolling Parent/Guardian will be permitted to complete this form
Child’s Name:
Parent/Guardian:
Cell Phone:
Agency:
Caseworker:
Caseworker Email:
Caseworker Cell Phone:
Authorized Visitor & Pick Up Release - Please list any individual who is authorized to pick up or visit your child, including yourself. Each authorized person must be at least 21 years of age. The above-named child will not be permitted to leave the program with anyone who is not listed below. Authorized individuals will be requested to show identification to program staff. Visitors cannot be same-age friends or acquaintances. Visitors must be a Caseworker, Therapist or Professional with knowledge of the child. Children will not be released to persons who fail to provide acceptable identification upon request. Please list the responsible persons with permission to pick up or visit your child from the program.
*Visitors must notify the Camp Director 12-24 hours in advance that their presence is expected. Camp activities will be in process and staff will need to make arrangements to ensure the child can be available.
Parent or Guardian Name*:
Signature of Parent or Guardian:
Genesis Hopeful Haven Media Release Form
Participant Name:
Address:
City:
State:
Zip:
By signing this form, I give Genesis Hopeful Haven permission to copyright, publish, or use any and all photographs which you take or have taken of me, or my property, or in which I may be included in whole or in part.
I waive any right to inspect or approve the finished product or the editorial copy that may be used in connection with my photos, or the use to which it may be applied.
I hereby release, and agree not to hold Genesis Hopeful Haven or any associated stakeholders to any liability by virtue of any blurring, distortion, alteration, retouching, optical illusion, or use in composite form, whether intentional or otherwise, that may occur or be produced in reproduction of the finished product.
I am over 18 years of age
Participant Full Name (Printed):
Participant Signature:
If minor or not their own guardian, parent or guardian must sign below.
I hereby certify that I am the parent or guardian of above mentioned individual land and give consent without reservations to the foregoing contract on behalf of him or her.
Email:
Phone:
2025 - Field Trip Permission Form
Date
Participant's name
Grade
Date of Birth
Gender
Age
Parent/Guardian name (print name)
Home Cell #
Allergies
Additional medical/behavioral concerns:
Address
Emergency contact name
Emergency contact phone number
I
(To be signed by the youth)
as a participant in the GHH Program, agree to
abide by rules and regulation of Genesis Hopeful Haven.
PARENT/GUARDIAN SIGNATURE:
FIELD TRIP: Aqua Challenge, Beautifying Homes, Ronald McDonald Center, Wow center, Perrine
Pool, Goulds Pool, Fun dimension, Family Paintballing Center, Urban Air, Miami Roller Rink, Fishing at Dania Beach, Paradise Cove, Skyzone, Evo Showbiz, Rapids.
Method of Transportation: Charter Bus - Do you agree for your child to be transported in a vehicle to each of these locations? Please check:
(To be signed by Parent/Guardian):
name of the child
Participating in Activity and Field Trips Sponsored by Genesis Hopeful Haven