I, the undersigned parent or guardian, hereby consent to my child participating in the Teen Retreat at the Anchorage Camp at Lake Waccamaw, NC, on June 10-12. I understand that this activity will include bus rides, gym activites, outdoor activities, and recreational water activities that could result in injuries or death. I certify that my child is able to participate in any and all of these activities. If my child has medical conditions which may be relevant to a physician in the event of an emergency, I have listed them below. If I cannot be reached within a reasonable period of time, as determined by church officials, I hereby authorize the church or the adult sponsor, Nathan Johnson to make emergency medical decisions for my child. If there are any activities that I do not want my child to be involved in, I have listed them below.
I UNDERSTAND AND HEREBY AGREE TO ASSUME ALL OF THE RISKS WHICH MAY BE ENCOUNTERED ON SAID ACTIVITIES, INCLUDING ACTIVITIES PRELIMINARY AND SUBSEQUENT THERETO. I do, for myself and for my child, heirs and assigns, hereby irrevocably and unconditionally release, acquit and forever discharge Victory Baptist Church and its agents, companies used, employees, and volunteers from any and all liability, actions, causes of actions, claims, expenses, obligations, and damages of any nature whatsoever, which I now have or which may arise in the future, in connection with my child’s participation in the described activity or in any other associated activities including, but not limited to, any injury to my child or property, even injury resulting in death.
I expressly agree that this release, waiver, and indemnity agreement is intended to be broad and inclusive as permitted by the law of the State of North Carolina, and that if any portion hereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. I expressly agree that any dispute arising from this activity shall be submitted to binding arbitration, to the extent it is not covered by insurance. This release contains the entire agreement between the parties hereto.
I further state that I HAVE CAREFULLY READ AND UNDERSTAND THE FOREGOING RELEASE AND KNOW THE CONTENTS HEREOF, AND I SIGN THIS RELEASE AS MY OWN FREE ACT. I understand that this is a legally binding agreement.