COUNSELOR IN TRAINING

Ages 12-16 | JUNE 17 – 21 | 9:00am-3:00pm

Please submit this form to register for NCAL’s Counselor in Training, for ages 12-16 starting June 17 – 21.

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"*" indicates required fields

PARTICIPANT INFORMATION

Participant's first and last name*

First Last

Does the participant have a nickname or chosen name we should use?

Participant's pronouns

Examples: She/her, He/him, They/them

Participant's date of birth*

What additional weeks are you available to help this summer*

June 24-28

July 8-12

July 15-19

July 22-26

July 29-August 2

August 5-9

August 12-16

August 19-23

Participants in our CIT camp will be asked to attend 2 additional weeks of summer camp (at no additional charge), where they will work alongside our experienced staff to facilitate camp activities and lessons.

PARENT / GUARDIAN INFORMATION

Parent/guardian’s full name (enter NA to each field if participant is 18 years or older)*

First Last

Email*

Phone*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Names and contact information for individuals authorized to pick up camper/program participant (if under 18 years old)*

*Please note NCAL will not allow campers under 18 years old to leave with any unlisted people unless notified in advance.

In case of emergency, please list TWO CONTACTS*

* PLEASE INCLUDE NAMES, PHONE NUMBERS & EMAILS

Comments/notes (if any)

Medical consideration/allergy information (if any)

Liability Waiver

Please read all fields carefully before indicating your agreement to all the terms and conditions below. 1. North Country Animal League (NCAL) assumes no responsibility for any injury or incident suffered by me or my child as a result of participation in NCAL programming either on or off NCAL premises. Neither my child or I, nor the heirs, administrators, executors, and assigns of either shall ever institute, or aid in the institution of any action at law or otherwise against NCAL on account of any injury to my child or I, or their/my property resulting from my/their program participation. I HEREBY RELEASE NCAL, its Board of Governors, Trustees, Officers, employees and agents from and against any and all claims for personal injuries to my child/I or loss of or damage to their/my property arising out of their/my activities as a NCAL program participant. 2. I agree to fully and forever release , indemnify and hold harmless North Country Animal League, and the officers and directors (“Indemnitees”), and their employees, owners, and other agents acting on behalf of or for Indemnitees from any and all liabilities due to injuries, death, claims, damages, actions or losses, which may arise out of my, my minor child’s, or my guest’s presence at North Country Animal League, including without limitation, ordinary negligence. 3. Except in the event of gross negligence or willful misconduct, I shall bring no claims, demands, actions or litigation against the Indemnitees or their employees, owners, its riding instructors, and other agents acting on behalf of or for the Indemnitees for any economic losses and non-economic losses due to bodily injury, death or property damage, sustained by me or my minor child (if applicable) in relation to the premises and operations of North Country Animal League.

I HAVE READ THIS WAIVER, INDEMNITY AND RELEASE OF LIABILITY AND FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND HAVE SIGNED IT FREELY AND WITHOUT ANY INDUCEMENT OR ASSURANCE OF ANY NATURE AND INTEND IT TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY VERMONT LAW AND AGREE THAT IF ANY PORTION OF THIS DOCUMENT IS HELD TO BE INVALID, THE BALANCE, NOTWITHSTANDING, SHALL CONTINUE IN FULL FORCE AND EFFECT.*

I agree.

I disagree.

COVID Safety Agreement - STAYING HOME WHEN APPROPRIATE:

1) While NCAL no longer requires masks, we encourage Staff, campers, parents/guardians and visitors to wear one if they experience potential COVID-19 symptoms, or stay home if they have tested positive or are showing symptoms of COVID-19. Symptoms include: Fever or chills; cough; shortness of breath or difficulty breathing; fatigue; muscle or body aches; headache; new loss of taste or smell; sore throat; congestion or runny nose; nausea or vomiting; diarrhea. 2) If camper/program participant begins to develop any COVID-19 symptoms during programming, parents/guardians will be immediately called to pick up camper/program participant. 3) Program participants should immediately let our staff know (riding@ncal.com) know if they have tested positive for COVID-19.

I HAVE READ THE ABOVE SAFETY AGREEMENT AND FULLY UNDERSTAND ITS TERMS, AND AGREE TO ITS TERMS AND CONDITIONS.*

I agree.

I disagree.

Cancellation Policy

Cancellation Policy: Any cancellations or requests to change sessions must be made prior to June 1 in order to receive a refund, minus a $50 administrative fee. Any cancellations or requests received from June 1 until 2 weeks to the start of the session will receive a 50% refund. Cancellations made within 2 weeks of the beginning of the session will not be eligible for any refund. Requests to change sessions will not be permitted within 2 weeks of the start date.

I HAVE READ THE ABOVE CANCELLATION POLICY AND FULLY UNDERSTAND ITS TERMS, AND AGREE TO ITS TERMS AND CONDITIONS.*

I agree.

I disagree.

Supervision Authorization*

By checking this box, you are indicating your understanding that supervision of your child is to be provided by North Country Animal League between drop-off and pick-up of the child.

I am above 18 years of age

Photo/Media Release

By checking this box, I authorize North Country Animal League (NCAL) to use the above named person’s image for NCAL's related printed and digital materials, without limitation, as NCAL shall in their sole discretion determine. This authorization is without date restriction. NCAL agrees that this photograph will not be given or sold to any individual or organization and will only be used for NCAL's promotional purposes.

If you choose not to give NCAL your/your child’s photo/media release, please email programs@ncal.com. Thank you.

How did you hear about this NCAL program?

Word of mouth

Online search

Looking through the website

Social media

Newsletter

Media outlet (radio, TV, newspaper, etc.)

Would you like to subscribe to our newsletter?*

Yes please!

No thank you.

Already receiving it.

REGISTER FOR CAMP

Please Read Carefully Before Choosing Your Option(s). Payment is due in full at time of registration or a financial assistance application must be submitted for review. CANCELLATION POLICY

Humane Education Camp: Ages 12-16 - JUNE 17 - JUNE 21

Price: $435.00

If you would you like to contribute to NCAL's Amelia Scholarship Fund to support local families, please enter your donation amount below:

In order to make our programming accessible for as many families as possible, we ask those with more access to resources to consider paying more tuition to help those with fewer economic opportunities.

Payment Method:

Credit/Debit Card

I will apply for Financial Assistance

Credit Card*

Cardholder Name

Card Details

Your Information:

Name

First Last

Billing Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

*Please feel free to skip if same as home address listed above

Check all that apply

I would like to cover the processing fee ($3)

Please email me the receipt

I do not need a receipt

Processing Fee

Total

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