Health Forms

To provide the safest possible program, all children attending a Drop-Off PUDDLESTOMPERS Program must submit a full health record upon registration. This record must include both a physical dated within 18 months of program start, and a full immunization record. Please contact your healthcare provider for a copy of this form. It can be emailed to healthforms@puddlestompers.com or mailed to us at:
_________________________

PUDDLESTOMPERS Nature Exploration
45 Puddingstone Lane,
Newton, MA 02459

Consent & Waiver Forms

In addition to a full health record, we also require a Consent Form & Waiver of Liability to be filled out for each Drop-Off PUDDLESTOMPERS program. If you are registering for Summer Camp 2025, please fill out the Summer Camp 2025 Consent Form. For all other drop-off programs, please submit the Drop Off Programs Consent Form 2024 or 2025 (dependent on the year of the program).

Waiver of Liability 2024

Item 1

I fully accept and assume all risk and responsibility as a result of the child(ren)s participation. I hereby release, waive, discharge and covenant not to sue PUDDLESTOMPERS™ Nature Exploration Inc. (henceforth referred to as PUDDLESTOMPERS™) , its owners, officers, instructors, employees, contractors and agents (“Releasees”) from any and all liability, claims, demands or causes of actions whatsoever, including but not limited to claims for personal injury, harm, death, loss, damage and/or damage to personal property that may occur while participating in PUDDLESTOMPERS™ programs and/or while on any premises where PUDDLESTOMPERS™ is running activities, classes and/or camps.

COVID-19

PUDDLESTOMPERS™ is taking preventative measures to decrease the spread of COVID-19 and is following mandated guidelines issued by the state of Massachusetts; however PUDDLESTOMPERS™ cannot guarantee that you or your child(ren) will not become infected with COVID-19 during participation in our programs. Attending PUDDLESTOMPERS™ drop-off programs could increase the chance of you or your child(ren) contracting COVID-19.

By checking this box, I acknowledge that participation in PUDDLESTOMPERS™ programs could result in injury to program participants and/or their exposure to illness and/or communicable diseases, including but not limited to COVID-19. I understand the risks of becoming exposed to or infected by COVID-19 at PUDDLESTOMPERS™ may result from the actions, omissions, or negligence of myself and others, including, but not limited to PUDDLESTOMPERS™ employees, and program participants and their families.

Item 3

I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child(ren) or myself (including, but not limited to disability, personal injury, and death), illness, loss, claim, damage, liability, or expense, of any kind, that I or my child(ren) may experience or incur in connection with my child(ren)’s attendance at any PUDDLESTOMPERS™ program (“Claims”). On my behalf, and on behalf of my children, I hereby release, covenant not to sue, discharge, and hold harmless PUDDLESTOMPERS™ its employees, agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind emerging out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of PUDDLESTOMPERS™, its employees, agents, representatives, and program participants and their families whether a COVID-19 infection happens before, during, or after participation in any PUDDELSTOMPERS™ program.

Item 4

By checking this box, you are electronically signing to all terms stated above.

Name of Parent/Legal Guardian

First Name

Last Name

Name of PUDDLESTOMPERS™ Participant

First Name

Last Name

Additional Names of PUDDLESTOMPERS'™ Participants

Today's Date

MM

DD

YYYY

Waiver of Liability 2025

I fully accept and assume all risk and responsibility as a result of the child(ren)s participation. I hereby release, waive, discharge and covenant not to sue PUDDLESTOMPERS™ Nature Exploration Inc. (henceforth referred to as PUDDLESTOMPERS™) , its owners, officers, instructors, employees, contractors and agents (“Releasees”) from any and all liability, claims, demands or causes of actions whatsoever, including but not limited to claims for personal injury, harm, death, loss, damage and/or damage to personal property that may occur while participating in PUDDLESTOMPERS™ programs and/or while on any premises where PUDDLESTOMPERS™ is running activities, classes and/or camps.

Covid-19

PUDDLESTOMPERS™ is taking preventative measures to decrease the spread of COVID-19 and is following mandated guidelines issued by the state of Massachusetts; however PUDDLESTOMPERS™ cannot guarantee that you or your child(ren) will not become infected with COVID-19 during participation in our programs. Attending PUDDLESTOMPERS™ drop-off programs could increase the chance of you or your child(ren) contracting COVID-19.

By checking this box, I acknowledge that participation in PUDDLESTOMPERS™ programs could result in injury to program participants and/or their exposure to illness and/or communicable diseases, including but not limited to COVID-19. I understand the risks of becoming exposed to or infected by COVID-19 at PUDDLESTOMPERS™ may result from the actions, omissions, or negligence of myself and others, including, but not limited to PUDDLESTOMPERS™ employees, and program participants and their families.

I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child(ren) or myself (including, but not limited to disability, personal injury, and death), illness, loss, claim, damage, liability, or expense, of any kind, that I or my child(ren) may experience or incur in connection with my child(ren)’s attendance at any PUDDLESTOMPERS™ program (“Claims”). On my behalf, and on behalf of my children, I hereby release, covenant not to sue, discharge, and hold harmless PUDDLESTOMPERS™ its employees, agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind emerging out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of PUDDLESTOMPERS™, its employees, agents, representatives, and program participants and their families whether a COVID-19 infection happens before, during, or after participation in any PUDDELSTOMPERS™ program.

By checking this box, you are electronically signing to all terms stated above.

Name of Parent/Legal Guardian

First Name

Last Name

Name of PUDDLESTOMPERS'™ Participant

First Name

Last Name

Additional Names of PUDDLESTOMPERS'™ Participants

Today's Date

MM

DD

YYYY

Health & Consent Forms

Name

First Name

Last Name

Email

Subject

Message

^Please fill out this Waiver for ALL Drop-Off Programs (including Summer Camp)

Summer Camp 2025 Consent Form

Parent's/Legal Guardian's Name

First Name

Last Name

Child's Name

First Name

Last Name

I, parent or legal guardian of the child listed above, give consent for my child to attend PUDDLESTOMPERS Nature Exploration Drop-off Programs.

Emergency Medical Consent

I hereby authorize the PUDDLESTOMPERS™ Nature Exploration Inc. (henceforth referred to as PUDDLESTOMPERS™) staff or other appropriate personnel to provide first aid, emergency medical care, or if necessary, admission to an accredited hospital, when such care is necessary for the treatment of any injuries, allergic reactions or illness my child may sustain while participating in any activity associated with PUDDLESTOMPERS™

Emergency Contact Name

First Name

Last Name

Emergency Contact Phone Number

(###)

###

####

Sunscreen/Insect Repellent Consent

Emergency Epinephrine Use

In the event that my child has allergies, I will provide the appropriate medications and documentations, possibly including an emergency epinephrine dispenser. I, parent or legal guardian of the child named above, give consent for any trained adult along with the trained Health Care Supervisor to dispense emergency prescribed epinephrine to my child in the event of an allergic reaction.

Consent of Antihistamine Use

I, parent or legal guardian of the child listed above, understand that my child’s participation in PUDDLESTOMPERS™ drop off program will include various outdoor and indoor activities. As such, I acknowledge that it is possible that my child(ren) may encounter various insects/plants that may cause an anaphylactic reaction that is previously undiagnosed. I give consent for the trained Health Care Supervisor to dispense camp provided antihistamines in the event that my child experiences mild symptoms of an allergy.

Consent for Use of Hand Sanitizer

As a parent/guardian I understand that my child’s participation will include various outdoor and indoor activities with participants from various households. As such, I acknowledge that in order to maintain my child’s health and safety, frequent hand washing is necessary. Please select if you authorize the use of 60% alcohol-based on your child while under the supervision of PUDDLESTOMPERS staff.

^Please fill out this Consent Form for all Summer Camp 2025 Programs

Drop-off Programs Consent Forms 2024

Parent's/Legal Guardian's Name

First Name

Last Name

Child's Name

First Name

Last Name

I, parent or legal guardian of the child listed above, give consent for my child to attend PUDDLESTOMPERS Nature Exploration Drop-off Programs.

Emergency Medical Consent

I hereby authorize the PUDDLESTOMPERS™ Nature Exploration Inc. (henceforth referred to as PUDDLESTOMPERS™) staff or other appropriate personnel to provide first aid, emergency medical care, or if necessary, admission to an accredited hospital, when such care is necessary for the treatment of any injuries, allergic reactions or illness my child may sustain while participating in any activity associated with PUDDLESTOMPERS™

Sunscreen/Insect Repellent Consent

Emergency Contact Name

First Name

Last Name

Emergency Contact Phone Number

(###)

###

####

Secondary Emergency Contact Name

First Name

Last Name

Secondary Emergency Contact Number

(###)

###

####

Emergency Epinephrine Use

In the event that my child has allergies, I will provide the appropriate medications and documentations, possibly including an emergency epinephrine dispenser. I, parent or legal guardian of the child named above, give consent for any trained adult along with the trained Health Care Supervisor to dispense emergency prescribed epinephrine to my child in the event of an allergic reaction.

Consent of Antihistamine Use

I, parent or legal guardian of the child listed above, understand that my child’s participation in PUDDLESTOMPERS™ drop off program will include various outdoor and indoor activities. As such, I acknowledge that it is possible that my child(ren) may encounter various insects/plants that may cause an anaphylactic reaction that is previously undiagnosed. I give consent for the trained Health Care Supervisor to dispense camp provided antihistamines in the event that my child experiences mild symptoms of an allergy.

Consent for Use of Hand Sanitizer

As a parent/guardian I understand that my child’s participation will include various outdoor and indoor activities with participants from various households. As such, I acknowledge that in order to maintain my child’s health and safety, frequent hand washing is necessary. Please select if you authorize the use of 60% alcohol-based on your child while under the supervision of PUDDLESTOMPERS staff.

Drop-off Programs Consent Forms 2025

Parent's/Legal Guardian's Name

First Name

Last Name

Child's Name

First Name

Last Name

Item 3

I, parent or legal guardian of the child listed above, give consent for my child to attend PUDDLESTOMPERS Nature Exploration Drop-off Programs.

Emergency Medical Consent

I hereby authorize the PUDDLESTOMPERS™ Nature Exploration Inc. (henceforth referred to as PUDDLESTOMPERS™) staff or other appropriate personnel to provide first aid, emergency medical care, or if necessary, admission to an accredited hospital, when such care is necessary for the treatment of any injuries, allergic reactions or illness my child may sustain while participating in any activity associated with PUDDLESTOMPERS™

Sunscreen/Insect Repellent Consent

Emergency Contact Name

First Name

Last Name

Emergency Contact Phone Number

(###)

###

####

Secondary Emergency Contact Name

First Name

Last Name

Secondary Emergency Contact Number

(###)

###

####

Emergency Epinephrine Use

In the event that my child has allergies, I will provide the appropriate medications and documentations, possibly including an emergency epinephrine dispenser. I, parent or legal guardian of the child named above, give consent for any trained adult along with the trained Health Care Supervisor to dispense emergency prescribed epinephrine to my child in the event of an allergic reaction.

Consent of Antihistamine Use

I, parent or legal guardian of the child listed above, understand that my child’s participation in PUDDLESTOMPERS™ drop off program will include various outdoor and indoor activities. As such, I acknowledge that it is possible that my child(ren) may encounter various insects/plants that may cause an anaphylactic reaction that is previously undiagnosed. I give consent for the trained Health Care Supervisor to dispense camp provided antihistamines in the event that my child experiences mild symptoms of an allergy.

Consent for Use of Hand Sanitizer

As a parent/guardian I understand that my child’s participation will include various outdoor and indoor activities with participants from various households. As such, I acknowledge that in order to maintain my child’s health and safety, frequent hand washing is necessary. Please select if you authorize the use of 60% alcohol-based on your child while under the supervision of PUDDLESTOMPERS staff.

^Please fill out this Consent Form for all other Drop-Off Programs
(Indigenous Peoples’ Day, Veterans Day, MLK Day, December/February/April Vacations)