Page 10 - Fall2025

Camps

HOLIDAY BREAK CAMP
REGISTRATION, WAIVERS
AGES 6-21 • MEGAN MAULDING
Get ready to turn your holiday break into an unforgettable adventure with WDSRA! Our action-packed camp
days are bursting with excitement- think games, field trips, crafts, music, and so much more! Plus, we’ll keep
Waiver and Release of All Claims
you on your toes with exciting field trips that add an extra dash of excitement to your holiday break. You will
& Assumption of Risk
receive further information and a detailed camp schedule one week before the program. You must send a sack
Please read this form carefully and be aware that in the signing
lunch each day unless otherwise noted.
and participating in this program/activity, you will be expressly
assuming the risk and legal liability and waiving and releasing
Note: Transportation is provided from WDSRA and Fort Hill. You may also meet on-site at the ARC Center in West
all claims for injuries, damages, or loss which you or your
Chicago. For safety reasons, Fort Hill drop off and pick up will be in the back parking lot.
minor child/ward might sustain as a result of participating in
any and all activities connected with and associated with this
program/activity (including transportation services, when
Ages 6-12
provided).

Location: ARC, West Chicago
Date I recognize and acknowledge that there are certain risks of Fee Code
Time
Day
physical injury to participants in this program/activity, and I
12/22, 12/23, 12/26 M/TU/F 9:00am-2:00pm $195 5420000-1
voluntarily agree to assume the full risk of any and all injuries,
damages or loss, regardless of severity, that my minor
12/29, 12/30, 1/2 M/TU/F 9:00am-2:00pm $195 6120000-1
child/ward may have (or accrue to me or my child/ward) as a
WDSRA Drop off: 8:30am • Pick up: 2:30pm
result of participating in this program/activity against
Fort Hill Drop off: 8:30am • Pick up: 2:30pm
WDSRA, including officials, agents, volunteers and employees
(hereinafter collectively referred as WDSRA).
ARC Drop off: 9:00am • Pick up: 2:00pm

I do hereby fully release and forever discharge WDSDA from
Ages 13-21
any and all claims for injuries, damages, or loss that my minor
child/ward or I may have or which may accrue to me or my
Location: ARC, West Chicago Photo/Video Release
minor child/ ward and arising out of, connected with, io in
Day
Code
Date any way associated with this program/activity. Time I hereby authorize and give my consent to WDSRA to
Fee
photograph/video my child (or me) or to obtain outside

12/22, 12/23, 12/26 M/TU/F 9:00am-2:00pm $195 5420000-2
In the event of an emergency, I understand and authorize
photographs/video of my child (or me) participating in
12/29, 12/30, 1/2 M/TU/F 9:00am-2:00pm $195 6120000-2
WDSRA staff and officials to secure from any licensed hospital,
WDSRA activities/events/programs, and without limitation,
physician and/or medical personnel any treatment deemed
WDSRA Drop off: 8:30am • Pick up: 2:30pm to use such photographs/video in connection with promoting/
necessary for immediate care for myself or minor/ward and
Fort Hill Drop off: 8:30am • Pick up: 2:30pm advertising the services, programs, and facilities of WDSRA,
agree that I will be responsible for payment of any and all
ARC Drop off: 9:00am • Pick up: 2:00pm without consideration of any kind.
medical services rendered.
SCAN HERE
FOR MORE
INFORMATION

ePACT securely collects the health and emergency contact information. With ePACT, you only need to complete
your child’s information once. Then, on a yearly basis you will simply need to verify that the information is correct.
Need to make a change? You can make changes at any time. We’ll be notied of your updates directly from ePACT.

10 52 REGISTER ONLINE AT WWW.WDSRA.COM
REGISTER ONLINE: WDSRA.COM