Home GMCF Camps Winter Camp Winter Camp Registration GMCF Winter camp registration Winter Camp Registration FormPlease fill out this form once per camper.Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form. – Step 1 of 5 a & cross Child InformationChild's Name *FirstLastChild's Date of Birth *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Child's Gender *MaleFemaleOther/Non-binaryMedical ConcernsMedical Provider Name *Medical Provider Phone Number *Medical Insurance Carrier (Medicaid, MVP, Blue cross BlueShield, etc.)Primary Insured/Subscriber NameFirstLastMedical Insurance ID NumberNextParent/Guardian InformationParent/Guardian Name *FirstLastParent/Guardian Email *Parent/Guardian Phone *Parent/Guardian Address *Address Line 1Address Line 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeAre you or your spouse a GMCF member? (GMCF Staff — please pick "No") *YesNoAre you a GMCF Staff member? *YesNoGMCF Membership discount detailsThank you for being a GMCF member! After registering, your membership will be verified. If your membership is not valid you will be charged an additional amount to equal the regular price.GMCF Staff discount detailsThank you for being GMCF Staff! After registering, your employment will be verified. If your employment is not valid you will be charged an additional amount to equal the regular price.Emergency Contact(must be different from registering parent/guardian)Emergency Contact Name *FirstLastEmergency Contact Phone *PreviousNextWAIVER OF LIABILITY & CODE OF CONDUCTWAIVER OF LIABILITY & CODE OF CONDUCT In consideration of my usage of Green Mountain Community Fitness, and or participation in its activities, I agree that if I engage in any physical exercise or activity or use of any club facility on the premises, I do such activities AT MY OWN RISK. This includes, without limitation, my use of the locker room, pool, spa, sauna, parking areas, sidewalks, any equipment within the club and my participation in any activity, class, program, competition, or instruction, whether on or off club premises. I agree that I am voluntarily participating in these activities and using the facilities and premises and assume all risk of injury, illness, death, damage or loss to me or my property that may result, including without limitation, any loss or theft of personal property. I agree on behalf of myself (and my personal representatives, heirs, executors, administrators, agents, and assigns) to release and discharge Green Mountain Community Fitness (and its affiliates, employees, agents, officers, directors, representatives, successors and assigns) from any and all claims and or causes of action (known or unknown) arising out of its negligence. I further agree to indemnify and hold harmless Green Mountain Community Fitness (and its affiliates, employees, agents, officers, directors, representatives, successors and assigns) for any and all claims arising out of my presence at and/or participation in Green Mountain Community Fitness premises or activities. This WAIVER AND RELEASE OF LIABILITY includes, without limitation, injuries which may occur as a result of 1)My use of any exercise equipment or facilities which may malfunction or break; 2) Improper maintenance of any exercise equipment or facilities; 3) Negligent instruction or supervision; or 4) My slipping and falling while in the club or on the premises or participating in club activities off the premises. I understand that this WAIVER AND RELEASE is intended to be as broad and inclusive as permitted by the laws of the State of Vermont and agrees that if any portion is held invalid, the remainder of the WAIVER AND RELEASE will continue in full legal force and effect. I further agree that the venue for any legal proceedings shall be in the State of Vermont, and shall be governed by the laws of the State of Vermont. GMCF CODE OF CONDUCT: All staff, members and guests of GMCF have the right to feel safe, secure and respected. This agreement helps us build a community that is rooted in kindness and support. We have a Zero Tolerance Policy for violations of our code of conduct. GMCF is a family friendly organization and we expect persons using the facilities to behave responsibly, and to respect the rights and dignity of others. Our Code of Conduct outlines prohibited actions, and is not necessarily all-inclusive of behaviors considered inappropriate within our facilities: Using or possessing illegal drugs on GMCF property, in vehicles, or at GMCF-sponsored events. Smoking or Vaping – GMCF and its property are smoke-free environments. Carrying or concealing a weapon or any object that may be used as a weapon. Harassment or Intimidation by words, gestures, body language, or any menacing behavior. Physical contact with another person in an aggressive or threatening manner. Verbally abusive behavior including vulgar language, swearing, name-calling, or shouting. Sexually explicit behavior including conversation, apparel, and any sexual contact with another person. Theft or Vandalism – any behavior that results in the destruction or loss of property. Solicitation within or on the grounds of GMCF. GMCF is committed to operating the finest fitness center in Central Vermont with first-class facilities, unrivaled instruction, and a friendly, professional staff. To promote safety and comfort for everyone, individuals are asked to act appropriately at all times when in our facility or participating in our programs. The protection of members and guests who are using GMCF facilities is of paramount concern to GMCF staff. Therefore, we reserve the right to deny access or membership to any person for any reason. Members and guests are encouraged to respectfully ask any person whose behavior threatens their comfort or safety to refrain from such behavior. Patrons of GMCF should immediately report all inappropriate behavior to GMCF staff. The GMCF Management will investigate all reported incidents. Management may suspend or terminate GMCF membership privileges at their discretion in cases of Code of Conduct violations. If you are invited to participate in a conversation or discussion regarding an incident, it is expected that you will engage fully and contribute to the resolution process. Active participation is essential for understanding the situation and ensuring that all perspectives are considered. I ACKNOWLEDGE THAT I CAREFULLY READ THIS WAIVER AND RELEASE AND FULLY UNDERSTAND THAT IT IS A RELEASE OF LIABILITY AND A COMMITMENT TO ABIDE BY THE CODE OF CONDUCT. I AM WAIVING ANY RIGHT THAT I MAY HAVE TO BRING A LEGAL ACTION TO ASSERT A CLAIM AGAINST GREEN MOUNTAIN COMMUNITY FITNESS FOR ANY CAUSE. PARENT’S OR GUARDIAN’S INDEMNIFICATION This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree to this release with all of its terms and conditions as provided above, for myself and my child or ward, and any heirs, assigns, and next of kin. I release and agree to hold harmless the Releasees from any and all liability incidents to my minor child’s or ward’s participation in this program as provided above, even if arising from the negligence or gross negligence of the releases, through their acts or omissions, to the fullest extent permitted by law.Parent/Guardian Signature (Enter full name) (Waiver) *Waiver of Liability & Code of Conduct Acknowledgment *I hereby acknowledge and agree to the aforementioned Waiver of Liability & Code of Conduct, for myself and on behalf of my minor childPreviousNextPHOTOGRAPHY RELEASEI am the parent or legal guardian of (“my child”), a participant of summer camp (“Program”), a program by Green Mountain Community Fitness, located in Berlin, Vermont. I hereby consent to the publication and use of my child’s name and/or my child’s likeness (“Likeness”) for the purpose of promotion, publicity, advertising, or other manner or media by Green Mountain Community Fitness (“GMCF”), or any other representative authorized to act on behalf of the afore-mentioned entity. Likeness shall include, but not be limited to, photographs, sound and/or video recordings, films, broadcasts, brochures, publications, reports, web pages, promotional materials or any other audio-visual, electronic, printed, tangible work in any media or format, now known or hereafter to become known, and/or reproductions of any of these. I agree that the actual material involved is and shall continue to be the property of GMCF and that neither I, nor my child, shall have any right of review or approval regarding the use of my child’s name and/or Likeness in such material. I hereby release and hold harmless, GMCF along with their respective employees, agents, affiliates, sponsors, or other representatives from any and all claims, demands, or causes of action arising out of the use of my child’s name and/or Likeness, in accordance with the terms of this release. I understand and agree that neither I, nor my child, will be compensated in any way for the use of my child’s name and/or Likeness by GMCF. Parent/Guardian Signature (Enter full name) (Photo Release) *Photography Consent *I agreeI do not agreePreviousNextCamp Selection – GMCF Members Only *1 GMCF Member camper – $250.00Camp Selection – Non-Members *1 Non-member camper – $295.00Camp Selection – GMCF Staff *1 GMCF Staff Camper – $225.00Total$0.00Secure Credit Card Information *PreviousSubmit