2023 Retreat Release Form

Please select which group you are with:*

If other, what is the name of your group:

Name*

First NameLast Name

Birthdate:*

Date

Age:*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Email*

example@example.com

Are you under 18 years of age?*

I, give permission to Lake Lavon Camp and Conference Center’s management, medical staff, and/or the group director to provide medical treatment that may be deemed necessary to insure the well-being of the named applicant. I, the undersigned do hereby verify that the above information is correct and I do hereby release and forever discharge all from any and all claims, demands, actions or cause of action arising out of damage or injury while participating in Lake Lavon Camp sponsored activities.

Initial here that you have read the above statement (Parent/Guardian initials if attendee is under the age of 18).*

AGREEMENT TO ATTEND, PARTICIPATE, ASSUMPTION OF RISK AND RELEASE OF LIABILITY

Lake Lavon Camp & Conference Center, hereinafter referred to as the "Camp" requires a signature for all attendees of the Camp and all participants of any Camp activity including, but not limited to, Challenge/Ropes Course (highs and lows), Warped Wall, Swimming Pool, Camping, Basketball, Football, Baseball, Softball, Volleyball, Nerf Battle, Horseshoes, Archery, Archery Tag, Rifle Range, Disc Golf, GaGa Ball, Bazooka Ball and any and all other camp and recreational sports and activities. Furthermore, this form releases the Camp to photograph and/or use photographs of myself or my child for use in its publications, advertising, promotional purposes, Internet, and/or visual presentations which inform people of the services and activities of Camp. The signature provided confirms Agreement to Attend, Participate, Assumption of Risk, and Release Form in order to attend Camp and to participate in any Camp activity. Attendance and Activities at Camp may include warms-ups, games, group initiative problems, high and low challenge course, and/or other rigorous physical adventure activities as well as exposure to the elements, exposure to animals, snakes and insects. Camp takes all reasonable precautions to ensure you a safe and enjoyable experience. Parts of the experience, by their nature, can be physically demanding and include varying levels of stress and anxiety, not all of which can be foreseen. The decision to attend the Camp and the decision to participate in any Camp activity at any level IS AT ALL TIMES COMPLETELY UP TO THE INDIVIDUAL'S CHOICE and, if there is attendance at the Camp and participation at any level of any Camp activity, there is a risk, which must be assumed by each attendee and by each participant. Although it is the Camp's goal to maintain the physical, emotional and social safety of each attendee and participant of the Camp, the physical, emotional and social risks must be assumed by each attendee and participant.

"I understand that attendance at the Camp and participation in any Camp activity may be physically and emotionally demanding. I recognize the inherent risk of physical and/or emotional injury of attending Camp and participating in any and/or all Camp activities. I understand that each participant must assume the risk of any injury, physical and/or emotional, and any financial responsibility that could result from attending Camp and participating in any Camp Activity. I agree to assume such risks and such responsibility. I, on my behalf, and on behalf of my heirs and assigns, hereby release, indemnify and hold harmless Lake Lavon Camp and Conference Center from any and all claims, physical and emotional, including bodily injury, that I may have that may be sustained in connection with my attending Camp and with my participation in any and/or all Camp activities."

If you feel that there are any activities in which you or your child should not be involved in, please describe for us on an attached sheet the activities (include name and church/group name on the attached sheet). I understand the directors of Lake Lavon Camp and Conference Center reserve the right to dismiss, without refund, any camper whose influence is detrimental to the operation of the camp, as determined by the discretion of the directors. I understand that the use of alcohol, tobacco products, and illegal drugs is strictly prohibited at all Lake Lavon Camp and Conference Center programs.

I have read (or had read to me) this complete document and I understand the information contained herein. I have freely and voluntarily signed this document.

Signature of Attendee*

Printed Signature*

Date*

Date

Parent/Legal Guardian Signature Date (if attendee is under the age of 18)

Printed Signature

Date

LLCCC has permission to use any photographs/videos of person listed on this form for brochures, videos, advertising, web page or other promotional items. I/we further understand that these photos/videos will only be used for LLCCC promotional purposes.

Everyone attending Lake Lavon Camp should understand that attending camp includes a certain amount of inherent risk and that it is a choice to attend. We at Lake Lavon Camp take every guests wellbeing very seriously. We are following the protocols set forth by the State of Texas and the CDC.

LAKE LAVON CAMP POLICIES

1. Prank supplies are not allowed (i.e. Shaving cream, water balloons, water guns/blasters, silly string) in the buildings. Please request Lake Lavon approval for use of these supplies outdoors.

2. Adult supervision is required at the pool/Swim Lake/ Lake Front/Ropes Course/Warrior Course etc. At no time is a student to go to these areas without adult supervision.

3. Drugs, alcohol, any form of tobacco, firearms, knives, or any other kind of weapon, or fireworks are NOT allowed.

4. Appropriate Godly dress attire is expected. Casual clothing is acceptable during all activities. Shorts (for boys and girls), skirts and skorts (for girls) should be no shorter than fingertip length. One piece modest swimsuits are requested. Swimsuits should only be worn at the swimming pool. Shoes are required to and from every activity.

5. Please refrain from Public Display of Affection (PDA) with girlfriends/boyfriends.

6. No fighting, physical aggression or bullying will be tolerated.

7. All snack items must be stored in sealable containers to prevent ants and other insects in the dorms and meeting rooms. Texas Department of Health regulations prohibit cooking in dorms without kitchens.

8. Guests are not allowed to bring pets on campus. No pets in the dorms, conference center or meeting rooms.

9. Students are to respect all adult leaders and follow their instructions.

10. Any graffiti clean-up costs will be charged to the responsible parties.

HAVE SPECIAL DIETARY NEEDS? We strive to accommodate all of our guests, however, due to the volume of guests that we serve, our ability to accommodate special dietary needs is limited. We are able to provide gluten-free, dairy-free and vegetarian options when given prior notice (at least 7 days). We are aware that peanut allergies are airborne. If you have a SEVERE peanut allergy, please note that below. In cases where we are not able to accommodate, we invite you to bring your own food and we will provide storage, refrigeration and access to a microwave. If this does not apply to you, please write "Not Applicable" below.*

If you have any allergies that are life-threatening, please contact Kalliope@lakelavoncamp.com - as we take these matters incredibly serious and wish to ensure that everything is prepared accordingly before your arrival.