In consideration of the privilege of using Kimball Camp Outdoor Center, I agree to assume the risk for any injuries, including death, that may be sustained by the participant named on this form while participating in activities planned and/or facilitated by Kimball Camp Outdoor Center, regardless of whether injury or death occurs on or off the Kimball Camp Outdoor Center campus. I further assume all responsibility for injury or death that occurs during the named participant's intended stay at Kimball Camp Outdoor that may result from the named participant's decision, whether intentional or unintentional, to decline to participate in a planned activity and/or depart from designated Kimball Camp Outdoor Center activity areas, grounds, staff supervision, or intended program. Further, I agree to indemnify, hold harmless, assume liability for and defend Kimball Camp Outdoor Center, its trustees, officers, employees, staff, members and agents from all costs and expenses including, but not limited to, attorney's fees, reasonable investigative and discovery costs, court costs, and any other sums which Kimball Camp Outdoor Center, its trustees, officers, employees, staff, members and agents may pay or become obligated to pay for injury, including death, to persons or damage to property resulting from the use of Kimball Camp Outdoor Center, or from our actions or omissions and arising from any cause, including vehicles, except for matters caused by the exclusive negligence or willful misconduct of Kimball Camp Outdoor Center, its trustees, officers, members and agents while acting within the scope of duties of such relationship to Kimball Camp Outdoor Center. By signing below, I hereby certify that I have the legal authority to sign this agreement on behalf of the participant named above.
With full knowledge of the facts and circumstances surrounding the ACTIVITY, I voluntarily participate in the ACTIVITY and assume the responsibilities and risks resulting from my participation, including all risk of property damage and injury to others and to myself. I agree to comply with all of the rules and conditions of participating in the ACTIVITY. I understand I am required to provide my insurance information and my personal policy is the primary billable insurance for any medical costs that may directly or indirectly result from my participation in the ACTIVITY. I understand there is limited secondary medical coverage that covers me for injury or illness while participating in the ACTIVITY. This limited medical coverage will cover me as the secondary insurance up to its limits. If the injury or illness exceeds the coverage limits, I have adequate applicable insurance necessary to provide for and pay any medical costs that may directly or indirectly result from my participation in the ACTIVITY; otherwise, I understand that I am solely responsible for any medical costs that may directly or indirectly result from my participation in the ACTIVITY in excess of the secondary coverage limits.
I will indemnify and hold the State of Michigan, acting by and through the Department of Licensing and Regulatory Affairs (LARA), on behalf of Kimball Camp, its employees, directors, officers, and agents (hereafter referred to as ORGANIZATION) harmless with respect to any and all claims, injuries, and costs associated with my participation in this ACTIVITY. Furthermore, I acknowledge that I am solely responsible for any action that I participate in associated with this ACTIVITY or around this ACTIVITY, regardless if occurring before, during or after the period of the ACTIVITY. I will conduct myself in a manner that is considerate of other participants and in accordance with ORGANIZATION Rules and Regulations (including Participant/Camper Code of Conduct, when applicable) and with any state and city laws or rules where the ACTIVITY is occurring. If this ACTIVITY is an off-campus ORGANIZATION sponsored event, such as field trips, conferences, research, experiential learning, extension of classroom learning, etc., I understand that conduct not acceptable in the classroom setting is not acceptable during this ACTIVITY and will be handled in accordance with camp policy.
To the extent permitted by law, and in consideration for being allowed to participate in the ACTIVITY, I hereby save, hold harmless, discharge and release the ORGANIZATION from any and all liability, claims, causes of actions, damages or demands of any kind and nature whatsoever that may arise from or in connection with my participation in any activities related to the ACTIVITY, whether caused by the negligence or carelessness of the ORGANIZATION or otherwise.
It is my express intent that this Acknowledgement of Risk and Waiver of Liability shall bind my spouse, the members of my family and my estate, heirs, administrators, personal representatives and assigns. I further agree to save and hold harmless, indemnify and defend the ORGANIZATION from any claim by the aforementioned parties arising out of my participation in the ACTIVITY.
I recognize and acknowledge that the ORGANIZATION makes no guarantees, warranties, representations, or other promises relative to the ACTIVITY, and assumes no liability or responsibility for injury or property damage that I may sustain as a result of participation in the ACTIVITY. I further understand and agree that this is a release of liability and indemnity agreement, and it is intended to be as broad and inclusive as permitted by law. If any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full force and legal effect.
I hereby certify that, with or without accommodation, I have no health-related reasons or problems that preclude or restrict my participation in the ACTIVITY. I hereby consent to and understand myself to be solely responsible for the cost of first aid, emergency medical care, and, if necessary, admission to an accredited hospital for executing such care or treatment for injuries that I may sustain while participating in any activity associated with the ACTIVITY.
In signing this Acknowledgement of Risk and Waiver of Liability I hereby acknowledge and represent: (a) that I have read this document in its entirety, understand it, and sign it voluntarily; and (b) that this Acknowledgement of Risk and Waiver of Liability is the entire agreement between the parties hereto and its terms are contractual and not a mere recital.
I certify that I am the parent or legal guardian of the above-named participant in the ACTIVITY. On behalf of myself and my spouse, partner, coguardian or any other person who claims the participant as a dependent, I have read the above agreement, I understand the contents of this Acknowledgement of Risk and Waiver of Liability, assent to its terms and conditions, and sign this Acknowledgement of Risk and Waiver of Liability of my own free act.
I acknowledge that my dependent and I have agreed to the terms and conditions of my dependent's participation in the ACTIVITY, and I hereby give my consent to participation by my dependent in the ACTIVITY, and to receive medical treatment determined to be necessary. I further agree to hold harmless, indemnify and defend the ORGANIZATION from and against all claims, demands or suits that my dependent has or may have.