MSK Challenge Course We are delighted to offer two challenge course sites totaling twelve low ropes course elements. A low ropes course utilizes ropes, cables, wooden beams, and tires strung among trees to promote healthy risk taking, have fun, build self-esteem and develop teamwork. The activities are challenging as students walk on logs and cables, navigate mazes, pass each other through giant webs, climb on elements, and swing on various obstacles. This growing resource is a result of funding by the Educational Foundation and the Get Kennebunk Moving fundraiser ~ May 2010. Community service will continue to be an integral part of the development and regular use of this resource. Overview Both challenge course sites were constructed by High 5 Adventure (July 2009 & July 2010). All students at the Middle School will have use of this challenge course. The benefits and values of a challenge course experience are numerous and long-lasting. The course will provide students with a dynamic way to learn while fostering a deeper connection to nature. Positive aspects include: · Building self esteem, compassion, empathy and respect for others · Promoting working together · Creating an active hands on approach to solving problems and communicating ideas · Building of strength, agility and endurance Between August 2009-2010, twenty five staff members participated in a two-day training. Learning involved a foundation in adventure theory, low challenge course operational skills, spotting techniques, techniques for maximizing the challenge course experiences, and processing techniques. All staff at the Middle School have been introduced to the course. The included paperwork is necessary for your student to participate in this program. Student Program Information, Assumption of Risks and Agreements of Release and Indemnity School Name: MSK KES SRS Consolidated KHS ML Day Dear Parent/Guardian: Welcome to the Middle School of the Kennebunks’ Challenge Course. Please read this document carefully. Parts I, II and III seek medical and other information about your child. Part IV contains important information about the Challenge Course experiences and may affect your legal rights and those of your child in the event of an injury or some other loss. At least one parent/ guardian must sign the document. Activities and Risks: The MSK Challenge Course program is designed to be age appropriate and well within the capabilities of children in reasonable good health. The program incorporates a variety of activities including games and problem solving initiatives. Each child may choose the level of his or her participation. Minimizing risks is a high priority, but participants must assume those risks. While the risk of injury is small, participants may suffer sprains, abrasions and other, more serious, physical and emotional trauma. Injuries and other losses can result from, among other causes, moderate to strenuous activity including the possibility of falling, abrupt contact with fixed and other objects and persons, close personal contact with other participants or staff members, including the possibility of inadvertent and unwelcome touching, and misjudgments of other participants. Middle School of the Kennebunks recommends that participants be covered by health and accident insurance for the duration of their participation. Managing risks effectively is very important in all of our programming at Middle School of the Kennebunks. Please help us by providing the information requested below. Let us know if you child has any conditions (current or past) that could affect his/her involvement in all activities and provide any other information that will help us provide a productive and enjoyable experience. Part I – General Information Student’s Name __________________________________________ Date of Birth ______________ Address ___________________________________________________Sex Male _____ Female ____ Name of Parent/Guardian _________________________________ Home Phone # _____________ Address __________________________________________________ Work Phone # _____________ In case of emergency and you are not available, please give the name of someone else to notify. Name ________________________________________ Relationship to Student ________________ Phone # ______________________________________ Address ______________________________________ Part II – Insurance Information Is the
student covered by medical insurance? Yes _____ No
_____ Name of
Insurance Carrier ______________________________ Policy # _____________________ Name of Insured ________________________________Relationship to Student ______________ Part III – Medical Information Does the student have any medical conditions (current or past) that could affect his/her ability to fully participate in the Middle School of the Kennebunks challenge course programs? Yes _____ No _____ If you answered Yes, please explain. __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Is the student currently taking any medications? Yes _____ No _____ If Yes, please give the name of the medication(s) and describe the condition for which it has been prescribed. __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Does the student have allergies? Yes _____ No _____ Does the student have chronic or recurring illness? Yes _____ No _____ Has the student had a recent injury or infectious disease? Yes _____ No _____ Does the student have any seizure disorders? Yes _____ No _____ If you answered Yes to any of the above, please explain: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Part IV- Assumptions of Risks, and Agreements of Release and Indemnity In consideration of the services of the Middle School of the Kennebunks in offering these activities, I, parent/guardian, for myself and on behalf of my minor child, agree as follows: Assumption of Risks: I am aware that the Middle School of the Kennebunks’ Challenge Course is meant to be physically challenging as well as educational. I understand that even though Middle School of the Kennebunks' programs are designed and operated by skilled and experienced staff, the risks of injury cannot be eliminated. I understand further that the risks describes above, and others risks, are inherent in the activities – that is, they cannot be eliminated without changing the nature and value of the experiences. I have discussed Middle School of the Kennebunks' activities and their risks with my child. He or she understands them and wishes to participate nevertheless, and the childe and I expressly assume all such risks, inherent and otherwise and whether or not they are described above. Release and Indemnity: For myself and, to the maximum extent allowed by law, on behalf of my child, I agree to release and to indemnify (“indemnify” meaning to protect, defend and pay any judgments, costs, and attorney’s fees) Middle School of the Kennebunks', and RSU 21, with respect to any and all claims of negligence (but not of gross negligence wrongful conduct), arising in any way from injuries or other loses suffered by the child or caused by the child, in connections with child’s enrollment or participation in a Middle School of the Kennebunks' activity. Other: In the event of illness or injury to the child, consent is herby given to provide emergency medical care, hospitalization or other treatment, which may become necessary, and to exchange medical information with third party caregivers. I will pay or reimburse Middle School of the Kennebunks/RSU 21 or any other Released Party for any and all costs including attorney fees, associated with defending a claim bought by me or by or on behalf of my child to the extent that claim is dismissed or recovery for it is denied. If a suit is filed against Middle School of the Kennebunks/ RSU 21 or any other released party it must be filed within York County, Maine. Any such suit will be governed by the laws of the State of Maine, not including those laws which may apply the laws of another jurisdiction. If a court of competent jurisdiction deems any part of this agreement invalid, the remainder of the agreement will nevertheless remain in full force and effect. Signature of Parent/Guardian ______________________________ Date ____________________
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