User account

Create a fun user name, enter your email and we will send you a temporary password to log on. Then change your password.
Spaces are allowed; punctuation is not allowed except for periods, hyphens, and underscores.
A valid e-mail address. All e-mails from the system will be sent to this address. The e-mail address is not made public and will only be used if you wish to receive a new password or wish to receive certain news or notifications by e-mail.
Provide a password for the new account in both fields.

AYA Waiver, Release, Consent and Disclosure

AYA camp offers a range of programs and activities that inspire individuals to pursue personal growth through outdoor activity and education. The camp activities may challenge and engage the physical, mental and emotional resources of each participant. In addition, all recreational activities carry an inherent risk of injury. Some risks may include, but are not limited to, injury from slipping, falling, running or jumping, and equipment failure. Physical injuries may include but are not limited to cuts, abrasions, sprains, broken bones, concussions, head injuries, spinal injuries and/or death. Please read the following carefully and be aware that you are expressly assuming the risk and legal liability and waiving and releasing all claims for injuries, damages or losses which you or your minor child/ward might sustain as a result of participating in the activities.

Participant Name______________________________________ Date_______________

AYA Program Name___________________________________________________________

Parent/Guardian Name__________________________________


Phone (Home)________________ (Work)_______________ (Mobile)_______________

Other individuals authorized to make medical decisions on behalf of my child in the event I am unable to be reached:

Name_______________________________ Relationship_________________________

Phone (Home)________________ (Work)_______________ (Mobile)_______________

Name_______________________________ Relationship_________________________

Phone (Home)________________ (Work)_______________ (Mobile)_______________

The following Camp Waiver, Consent, and Releases must be read and understood as indicated by Parent/Guardian signature(s).

Release Waiver
In consideration of participation in the activities of AYA School Break Camps and Programs, I/We do hereby fully release and discharge, and save whole and harmless AYA officers and staff from any and all liability for dmages or claims for damages, causes of action, claims, demands, costs, expenses and compensation of any nature whatsoever, and any known and unknown personal injuries, sickness, illness, or disorder, which I/We may now hereafter have (as parents and/or guardian of our minor child/children, and also claims or rights of action for damages which the said minor child/children has/have or may hereafter arising out of or connected with participation in any activities whatsoever of AYA.

I/We further state that I/We have carefully read the above release waiver and know the contents thereof, and I/we sign the same as my/our free act and deed.

Parent/Guardian Signature_________________________________________Date________

Consent for Medical Treatment
As the parent/guardian of the minor listed above, I hereby authorize the treatment by qualified and licensed medical personnel in the event of a medical emergency. This authority is granted only after a reasonable effort has been made to reach me utilizing the contact information provided above.


Medical Disclosure
Specific medical allergies or other conditions______________________________

Another additional information AYA Camp Staff should be aware of regarding your minor child/ward_______________________________________________________