Summer Healing Camp Registration

Summer Healing camp is a program serving youth (5 - 12 years old) who are interested in a combination of a traditional outdoor camp on a small farm, field trips, cultural competency, skills building, vocations, arts and crafts, feeding animals, holistic healing, learning history, social/emotional wellness, swimming + daily activities. Priority is especially given to those who lost a loved one to violence, though all are welcome to register to attend. This form is to pre-register your child for our healing camp, you are still required to attend our mandatory information session on July 16th at 5pm to secure your students placement.

Event Timing: July 29th through August 16th
Event Address: 1706 Laurens St, Baltimore, MD 21217

Contact us at (443) 869-2694 or  anna@fsnwork.org

Acknowledgment, Waiver, and Release of Liability

I give permission to Family Survivor Network Inc (FSN) to use photos, videos, testimonials and recordings for communication, marketing, and promotional needs. 

I understand I hereby confirm the participant is in good health and able to participate in the activity. I acknowledge the activity may be physically involved. I fully accept and acknowledge the activities may involve risk, and I hereby assume the risk and responsibility for all dangers and risks associated with the participant of the activity. I further understand that concussion information is available at www.cdc.gov/concussions. 

I acknowledge Family Survivor Network (FSN) and their respective employees, directors, officers, volunteers, members and any other participant, entity, party or person involved in any regard with the activity or the activity premises and their respective agents, personal representatives, heirs, employees, contractors, successors and assigns (each on "activity representative" and collectively the "activity representatives"), shall not be responsible or liable in any regard or manner for any and all property damage or bodily injury incurred by participant or any party related thereto as a result of his/her participation. 

I understand I hereby unconditionally release, discharge, covenant not to sue, waive my rights and remedies, and agree to hold harmless the activity representatives from any and all claims, costs, demands, losses, damages, or expenses associated with, in whole or in part, participant's involvement with the activity. I certify all answers and information provided on this registration form are to the best of my knowledge true and correct throughout the activity. I shall inform the Family Survivor Network (FSN) in writing if any information provided in this registration form is incorrect or changes through the course of the activity. I understand Family Survivor Network (FSN) does not perform criminal and/or background checks on external third-party activity representatives. I shall present a government-issued photo identification card including, but not limited to, my drivers license, passport, or United States Visa to Family Survivor Network (FSN) for confirmation and review, if requested, at the time I submit this Form to the Family Survivor Network (FSN). I hereby affirm that the information provided herein is true and correct to the best of his or her knowledge, information and belief. Additionally, I have read, fully understand, and hereby freely sign, approve of, and agree to the terms of this form.