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Life Camp Form

April 18, 2026

10:00am - 5:00pm
Santa Cruz, CA
$275 per child
Foundational life skills in nature, plants, animals, insects, physical awareness, food prep skills, and community involvement.

Child's Information

Full Name

Age

Birth Date

Grade

Home Address

Parent/Guardian Information

Full Name

Email

Phone Number

Address

Medical Information

Allergies?

(food, medication, environmental) - if none, type N/A.

Chronic Conditions

(e.g., asthma, diabetes) - if none, type N/A.

Current medications and dosage instructions.

If none, just type N/A.

Physician’s name and phone number.

Emergency Contacts & Authorized Pickup

Name, relationship to child, and phone number (primary/secondary)

List of individuals authorized to pick up the child.

Behavioral/Special Needs

If applicable, please list any behavioral or other special needs your child may have, or just write N/A, if none.

Can your child swim?

Can your child swim?
A
B

RELEASE AND WAIVER OF LIABILITY AGREEMENT

Please fill out the Liability Waver Agreement and sign below.

I, the below signed Participant, acknowledge that I voluntarily choose to participate in

the activities provided by Red Earth Movement (the “Agency”) including but not limited

to Life Camp for Boys (the “Event”).

I AM AWARE THAT ALL ACTIVITIES CONTAIN SOME DEGREE OF RISK AND MAY

BE HAZARDOUS ACTIVITIES AND THAT I COULD BE SERIOUSLY INJURED OR

EVEN KILLED. I AM VOLUNTARILY PARTICIPATING IN THESE ACTIVITIES WITH

KNOWLEDGE OF THE DANGER INVOLVED, AND AGREE TO ASSUME ANY AND

ALL RISKS OF BODILY INJURY, DEATH OR PROPERTY DAMAGE, WHETHER

THOSE RISKS ARE KNOWN OR UNKNOWN.

I am reasonably healthy, and have no minor or serious mental or physical injury,

disability or illness that could potentially render me particularly susceptible to injury,

or disability while participating in the workshop.

As consideration for my participation in the Event, I hereby release the AGENCY, any

AGENCY affiliated organization, and their respective directors, officers, employees,

volunteers, agents, contractors, and representatives (collectively “Releasees”) from any

and all actions, claims, or demands that I, my assignees, heirs, distributees, guardians,

next of kin, spouse and legal representatives now have, or may have in the future, for

injury, death, or property damage, related to (i) my participation in these activities, (ii)

the negligence or other acts, whether directly connected to these activities or not, and

however caused, by any Releasee, or (iii) the condition of the premises where these

activities occur, whether or not I am then participating in the activities. I also agree that

I, my assignees, heirs, distributees, guardians, next of kin, spouse and legal

representatives will not make a claim against, sue, or attach the property of any

Releasee in connection with any of the matters covered by the foregoing release.

I agree to participation in the Event. I am aware of the risks involved and fully

understand and accept each and every one of the risks associated with my participation

encompassing, without restriction, sickness or unanticipated allergic reaction, injuries

(e.g., without exception, those arising out of lack of coordination, clumsiness or

inattention, other participants) or exposure to Coronavirus Covid-19 and/or death.

Despite the above I assume all related risks, both known and unknown to me

concerning my participation at the Event. MY PARTICIPATION IS AT MY OWN SOLE

RISK.

By purchasing tickets and participating I understand the legal consequences of doing so

which includes a release of the Company from all liability related to the Event and

promising not to sue the Company and assuming all risks involved in the workshop

known or unknown. I am also agreeing to allow the Company to use my name and

likeness in its promotional activity. I am willingly participating with the above clear

understanding and I take 100% accountability 100% of the time for my thoughts, my

feelings, my words, and my actions.

Participant's Name

Participant or Parent/Guardian Signature

Signature

Today's Date

List of Any Allergies

Type N/A if not applicable.

Email

Phone

Emergency Contact Number

Payment

Please send your payment of $275 (per child) to Red Earth Movement via Venmo.
VENMO HERE →

Once you sign the Liability Waver and make your payment through Venmo, please hit submit below.

You will then receive more details about the camp in the response email.
Thanks so much for taking the time to fill out this form! We a