Register and Pay In Person - Five Day Flex Pass - Please enable JavaScript in your browser to complete this form.JSSC REGISTRATION IN PERSON (Five-Day Flex Pass) Camper's Information Camper's Name *FirstLastCamper's Phone (if applicable)Date of Birth *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Has the Camper ever been on a skimboard before? *YesNoDoes the Camper need to borrow a skimboard? *YesNoCamper's Ability Level *BeginnerIntermediateParent/Legal Guardian's Information (Enter your own name/info if you are registering for yourself and over age 18) Parent/Legal Guardian's Name *FirstLastEmail *Phone *Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeHow did you hear about us?Waiver Agreement *I have read and agree to all the terms in the below waivers:STANDARD WAIVER TERMS: This registration was completed by the Registrant who is above the age of 18, or the parent or legal guardian of the Camp Participant, and you agree to and accept the terms below: I (or the minor camp participant) can swim and acknowledge inherent risks of swimming in the ocean and potential injuries that may result by participating in water board sports. I agree to hold harmless JERSEY SHORE SKIM CAMP from all claims of liability which cause me (or the minor camp participant) damages of any nature in any way connected with participation in this activity. I also expressly agree to release and discharge JERSEY SHORE SKIM CAMP from any act or omission in rendering or failing to render any type of rescue, emergency or medical services. I further agree, to hold harmless JERSEY SHORE SKIM CAMP and the BOROUGH OF SEA BRIGHT from all defense costs, including attorney's fees incurred in connection with any claims arising from the activities that take place herein, whether caused by or sustained by any minor under 18 years of age on whose behalf I am signing, or which I may have caused to spectators or other third parties, whether negligent or not, in the course of my participation in this activity. COVID-19 WAIVER TERMS ASSUMPTION OF RISK / WAIVER OF LIABILITY / INDEMNIFICATION AGREEMENT In consideration of participating in Jersey Shore Skim Camp’s summer program, the undersigned acknowledges and agrees that: 1. Participation includes possible exposure to and illness from infectious diseases including but not limited to MRSA, influenza, and COVID-19. While the camp’s guidelines and personal discipline may reduce this risk, the risk of serious illness does exist. 2. I knowingly and freely assume all such risks, both known and unknown, even if arising from the negligence of the camp or Borough of Sea Bright or others and assume full responsibility for my children’s participation. 3. I willingly agree to comply with the stated and customary terms and conditions for participation as regards protection against infectious diseases. If, however, I observe any unusual or significant hazard during my presence or children’s participation, I will bring it to the attention of the nearest camp official or instructor immediately. 4. I, for myself and on behalf of my children, hereby release and hold harmless Jersey Shore Skim Camp, their officers, officials, agents, and/or employees, the Borough of Sea Bright, other participants, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event, with respect to any and all illness, disability, death, or loss or damage to person or property, whether arising from the negligence of releasees or otherwise, to the fullest extent permitted by law. By submitting the online registration I certify, as parent/guardian or legal adult, with legal responsibility for this Jersey Shore Skim Camp participant, I have read the provisions in this waiver/release, including the risks of presence and participation. I understand my role and my children’s personal responsibilities during camp hours for adhering to the rules and regulations for protection against communicable diseases. I, for myself, my spouse, and child/ward do consent and agree to his/her release provided above for all the releasees. Myself, my spouse, and child/ward do release and agree to indemnify and hold harmless Jersey Shore Skim Camp and the Borough of Sea Bright for any and all liabilities related to my child’s/ward’s presence or participation in the activities provided, even if arising from their negligence, to the fullest extent provided by law.Signature (Use finger/mouse pad to sign. Click X to re-do if necessary) *Clear SignatureCommentsSubmit