I. Consent to Treatment of a Minor
a. By signature below, the undersigned appoints all employees of Midcourse
Correction Challenge Camp Inc., each to act alone, or delegate to another person, the power to consent on our behalf to all emergency treatment and/or medical care (except elective surgery) determined
necessary or desirable by the attending physician at the hospital.
b. This Power of Attorney shall continue until revoked by the undersigned, or six months from the date signed
below, whichever is earlier. Physicians or the hospitalʼs medical staff may assume and rely on this authorization being current and in effect during such period unless notified otherwise.
c. The undersigned certify that they have read this Power of Attorney (or had it read to them), that they understand this Power of Attorney and sign it voluntarily.
d. Any person or entity may fully and completely rely on a copy of this Power of Attorney as if it were the original.
II. Release and Indemnity Agreement for Midcourse Correction Participants (Age 17 and under)
a. By signing below, I certify the following: (1) that my childʼs participation in Midcourse Correction Challenge Camp Inc. (Midcourse Correction) activities and programs, and my authorization of my childʼs participation
in Midcourse Correction activities and programs, is completely voluntary, and (2) that I have familiarized myself with the Midcourse Correction activities and programs in which my child will be participating. I
further recognize and have instructed my child in the importance of knowing and abiding by Midcourse Correctionʼs rules, regulations and procedures for the safety of camp participants, and (3) I understand that
Midcourse Correction reserves the right to refuse admission to any camper that they feel could be a detriment to any other campers, and (4) I understand and give permission that in the event my childʼs
behavior poses a risk of injury to themselves, staff or other campers Midcourse Correction staff may have to restrain my child using recognized and licensed means of restraint, and (5) I give permission to Midcourse
Correction to keep my child until picked up by the parent or legal guardian in the event my child wants to leave the camp.
b. I recognize that certain hazards and dangers are inherent in camping and sporting events and in the activities and programs conducted by Midcourse Correction, including, more specifically, but not limited to,
the activities of horseback riding, swimming, blobbing, rock climbing, swamp walk, high ropes, and zipline. I acknowledge that although Midcourse Correction has taken safety measures to minimize the risk of injury to
camp participants, Midcourse Correction cannot insure nor guarantee that the participants, equipment, premises and/or activities will be free of hazards, accidents and/or injuries. Moreover, I understand that
participation in any such activities may involve the risk of injury and loss, both to the person and to property, and that the risks may include the possibility of permanent disability or death, I assume all such risks connected with my childʼs participation in Midcourse Correction activities and programs.
c. I understand that in the unlikely event of a serious illness or injury, every effort will be made to notify the parent or legal guardians at the earliest possible time without jeopardizing the care of the camper or minor
staff. Parents or guardians will be notified if their child receives treatments for an injury/illness that requires a physician.
d. I understand that there may be elements of risk associated with activities at camp. I give permission for my child to participate in all activities at camp and hereby release and agree to indemnify and hold harmless
Midcourse Correction and Chenango Lake Retreat, their respective trustees, officers, employees, agents, and volunteers from any and all claims of any nature arising from such participation.
III. Photo Release
a. Photographs and video footage of my child as a result of participation in activities at Midcourse.