Summer & Trackout Camp Registration – SELECT WEEKS 1Registration2Camper Info3Terms & Parent Info4Payment Individual Week RegistrationYou will be asked to select the weeks that your camper(s) will be attending.Will you have more than one camper attending?* No Yes WeeksSelect all weeks your camper will attend:* Select All Week 40 (Oct 3-7) 2022 Week 41 (Oct 10-14) 2022 Week 42 (Oct 17-21) 2022 Week of Jan 2-6, 2023 Week of Jan 9-13, 2023 Week of Jan 16-20, 2023 Week of Mar 27-31, 2023 Week of Apr 3-7, 2023 Week of Apr 10-14, 2023 Week of Apr 17-21, 2023 HiddenHas this person ever attended Camp at Rush Hour Karting? Yes Has this person(s) ever attended Camp at Rush Hour Karting?* Yes No Indicate all weeks your camper(s) will attendNumber of campers for Week 40 (Oct 3-7) 2022 Price: $300.00 Quantity: Number of campers for Week 41 (Oct 10-14) 2022 Price: $300.00 Quantity: Number of campers for Week 42 (Oct 17-21) 2022 Price: $300.00 Quantity: Number of campers for Week of Jan 2-6, 2023 Price: $300.00 Quantity: Number of campers for Week of Jan 9-13, 2023 Price: $300.00 Quantity: Number of campers for Week of Jan 16-20, 2023 Price: $300.00 Quantity: Number of campers for Week of Mar 27-31, 2023 Price: $300.00 Quantity: Number of campers for Week of Apr 3-7, 2023 Price: $300.00 Quantity: Number of campers for Week of Apr 10-14, 2023 Price: $300.00 Quantity: Number of campers for Week of Apr 17-21, 2023 Price: $300.00 Quantity: Total $0.00 Camper InfoCampers' name, date of birth, and t-shirt size (YOUTH SM, YOUTH M, YOUTH L, YOUTH XL)* Each campers' name, date of birth, and t-shirt size (YOUTH SM, YOUTH M, YOUTH L, YOUTH XL)*One camper per line. Only enter the same number of campers that you paid for on the previous screen. Any additional campers entered here beyond that will not be considered registered.People that the camper(s) have permission to ride home with, and relation to child.*Do campers have permission to attend all activities both on and off site?* Yes No Please explainEmergency Contacts, with Phone Numbers*Camper's physician's name and contact phone*Do your campers have any food allergies? If so, explain.*Any medical conditions we need to know about? (IE: allergic to bee stings, etc)* Terms, Waivers & Guardian Contact InfoPARENTAL CONSENT, RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT IN CONSIDERATION of my minor child (“the Minor”) being permitted to participate in any way in the EVENT(S) and/or being permitted to enter for any purpose any RESTRICTED AREA(S) (defined to be any area which requires special authorization, credentials or permission to enter or any area to which admission by the general public is restricted or prohibited), I agree: I know the nature of the EVENT(S) and the Minor’s experience and capabilities, and believe the Minor to be qualified to participate in the Event(s). I will inspect the premises, facilities, and equipment to be used, or with which the Minor may come in contact. IF I OR THE MINOR BELIEVE ANYTHING IS UNSAFE, I WILL INSTRUCT THE MINOR TO IMMEDIATELY LEAVE THE RESTRICTED AREA AND REFUSE TO PARTICIPATE FURTHER IN THE EVENT(S). I FULLY UNDERSTAND and will instruct the Minor that: (a) THE ACTIVITIES OF THE EVENT(S) ARE VERY DANGEROUS and participation in the Event(s) and/or entry into Restricted Areas involves RISKS AND DANGERS OF SERIOUS BODILY INJURY, INCLUDING PERMANENT DISABILITY, PARALYSIS AND DEATH (“RISKS”); (b) these Risks and dangers may be caused by the Minor’s own actions, or inactions, the actions or inactions of others participating in the Event(s), the rules of the Event(s), the condition and layout of the premises and equipment, and/or THE NEGLIGENCE OF THE “RELEASEES” NAMED BELOW; (c) there may be OTHER RISKS NOT KNOWN TO ME or that are not readily foreseeable at this time; (d) THE SOCIAL AND ECONOMIC LOSSES and/or damages that could result from those Risk(s) COULD BE SEVERE AND COULD PERMANENTLY CHANGE THE MINOR’S FUTURE. I consent to the Minor’s participation in the Event(s) and/or entry into restricted areas and HEREBY ACCEPT AND ASSUME ALL SUCH RISKS, KNOWN AND UNKNOWN, AND ASSUME ALL RESPONSIBILITY FOR THE LOSSES, COSTS AND/OR DAMAGES FOLLOWING SUCH INJURY, DISABILITY, PARALYSIS OR DEATH, EVEN IF CAUSED, IN WHOLE OR IN PART, BY THE NEGLIGENCE OF THE “RELEASEES” NAMED BELOW. I HEREBY RELEASE, DISCHARGE AND COVENANT NOT TO SUE the promoters, participants, racing associations, sanctioning organizations or any subdivision thereof, track operators, track owners, officials, car owners, drivers, pit crews, rescue personnel, any persons in any Restricted Area, sponsors, advertisers, owners and lessees of premises used to conduct the Event(s), premises or event inspectors, surveyors, underwriters, consultants and other persons or entities who give recommendations, directions, or instructions or engage in risk evaluation or loss control activities regarding the premises or Event(s) and each of them, their directors, officers, agents, employees, representatives, owners, members, affiliates, successors and assigns, all for the purposes herein referred to as “Releasees,” FROM ALL LIABILITY TO ME, THE MINOR, my and the minor’s personal representatives, assigns, heirs, and next of kin, FOR ANY AND ALL CLAIMS, DEMANDS, LOSSES, OR DAMAGES ON ACCOUNT OF ANY INJURY TO ME OR THE MINOR, including, but not limited to, death or damage to property, CAUSED OR ALLEGED TO BE CAUSED, IN WHOLE OR IN PART, BY THE NEGLIGENCE OF THE “RELEASEES” OR OTHERWISE. If, despite this release, I, the Minor, or anyone on the Minor’s behalf, makes a claim against any of the “Releasees” named above, I AGREE TO DEFEND, INDEMNIFY AND SAVE AND HOLD HARMLESS THE RELEASEES and each of them from ANY LITIGATION EXPENSES, ATTORNEY FEES, LOSS, LIABILITY, DAMAGE, OR COST THEY MAY INCUR DUE TO THE CLAIM MADE AGAINST ANY OF THE “RELEASEES” NAMED ABOVE, WHETHER THE CLAIM IS BASED ON THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE. I sign this agreement on my own behalf and on behalf of the Minor. I HAVE READ THIS PARENTAL CONSENT, RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT, UNDERSTAND THAT BY SIGNING IT I GIVE UP SUBSTANTIAL RIGHTS I AND/OR THE MINOR WOULD OTHERWISE HAVE TO RECOVER DAMAGES FOR LOSSES OCCASIONED BY THE RELEASEES’ FAULT, AND SIGN IT VOLUNTARILY AND WITHOUT INDUCEMENT.Continuing Assumption of Risk Agreement and Release In consideration of my child being allowed to ride go karts and / or participate in other recreational activities at RushHour, Inc., or while attending an activity on or off the premises with RushHour, Inc. staff, I, the undersigned, assume all responsibility for any and all risk of injury that may occur to any children that I register for this camp while participating in any activity with RushHour, Inc, including on any field trip. In consideration of such, I hereby release, hold harmless, discharge and covenant not to sue RushHour, Inc, its operators, employees, agents, supervisors, and other participants from all claims, demands, rights, or causes of action present or future, whether known or anticipated and resulting from or arising out of an incident to the undersigned’s participation with RushHour, Inc. This release / hold harmless agreement and waiver shall operate as an absolute bar to any and all claims, causes of action, or demand at law or equity, brought by or on behalf of the member, their heirs, executors, administrators and assigns, against any of the persons or organizations referenced above. Waiver Exclusion Clause I hereby assume all the risk and hazards incidental to the conduct of the activities in which I participate in at RushHour, Inc. I release, absolve and indemnify RushHour, Inc, its owners, managers, staff, and counselors from all risk and hazards associated with activities. In the event of injury, I do hereby expressly waive all claims against them. I understand that no insurance coverage is provided by RushHour, Inc. I am in agreement with the above, and have had time to read and fully understand this information. Discipline and Behavior Management Philosophy Praise and positive reinforcement are effective methods of behavior management of children. When children receive positive, Non-violent, and understanding interactions from adults and others, they develop good self-concepts, problem-solving abilities, and self-discipline. Based on this belief of how children learn and develop values, this facility will practice the following Discipline and Management Philosophy. Counselors will: Praise, reward and encourage children. Model appropriate behavior for the children. Listen to the children. Provide alternatives for inappropriate behavior to the children. Provide the children with natural and logical consequences of their behavior. Treat the children as people, and respect their needs, desires, and feelings. Use short supervised periods of time-out. Time Out: is the removal of a child for a short period of time (the time will not exceed the age of the child) from a situation in which the child is misbehaving and has not responded to verbal warnings. The “Time-Out” space, is located away from the camp activity, but still within the counselor’s sight. During Time-Out, the child will have a chance to reflect on their behavior which led to the removal from the group activity. After the Time-Out period is complete, the child will have a chance to discuss the misbehavior with the counselor, come up with a resolution to the problem and rejoin the group. When the incident is over, and the child rejoins the group, the incident is over, and the child is treated with the same respect as the other children. Stay consistent with our Behavior and Discipline Matrix. RushHour understands that racing is an adrenaline filled sport; however, aggressive behavior of any nature, to include throwing equipment, verbal insults ect., will not be tolerated. *Dismissal from camp will result in the forfeit of all funds paid for RushHour Summer Camp/ TrackOut Camp* Counselors will NOT: Spank, bite, pinch, push, pull, slap, or otherwise physically punish the children. Make fun of, yell at, threaten, make sarcastic remarks about, use profanity, or otherwise verbally abuse the children. Deny food or rest as punishment. Leave the children alone, unattended, or without supervision. Criticize, make fun of, or otherwise belittle children’s parents, families, or ethnic groups. I, the undersigned parent or guardian of the children I enroll, do hereby state that I have read, received a copy of, and understand the facility’s Behavior Management Philosophy and Behavior Matrix. I understand that the dismissal of the children I enroll will result in the forfeit of funds paid for Summer Camp/TrackOut Camp at RushHour Karting, Inc. Transportation Form Permission Slip & Medical Release I, (parent / guardian) hereby give RushHour, Inc. permission for my child(ren) to go on any field trip that RushHour, Inc. should take. This permission slip is valid as long as my child is enrolled for the Karting Academy / Summer Camp at RushHour, Inc. I hereby release RushHour, Inc. from any and all liability while my child(ren) are on the field trip. I give RushHour, Inc. permission to administer basic first aid, if needed, and I give permission to any licensed medical facility or doctor to administer medical care to my child(ren) if any emergency situation arises at any time. I, the undersigned parent or guardian of of all children I register for camp, do hereby state that I have read and understand this Permission Slip and Medical Release, and agree to adhere with all policies stated here. By signing below, I agree to all policies and terms aboveI have read and agree to the Rush Hour Terms Waiver*Please sign your nameGuardian InfoParent/Guardian's Name* First Last Parent/Guardian's Email* Parent/Guardian's Phone Number(s)*Parent/Guardian's Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code PaymentDo you have a discount code?* No Yes Discount* Total $0.00 Credit Card* American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20222023202420252026202720282029203020312032203320342035203620372038203920402041 Expiration Date Security Code Cardholder Name NameThis field is for validation purposes and should be left unchanged.