AUTHORIZATION FOR TREATMENT, PARENTAL CONSENT AND RELEASE OF LIABILITY:
As the parent or guardian of the above named applicant, I hereby give my approval and consent for my child to participate in Camp Falling Spring (CFS), July 13-18, 2025. In addition, I hereby release The Presbyterian Church of Falling Spring (PCFS), its staff and volunteer leaders, and the members of Falling Spring Horse Valley Acres (FSHVA) from any and all liability for sickness, accidents, or injuries of any nature or cause whatsoever, including the negligence of PCFS and FSHVA, while participating and/or traveling to and from. I understand I am releasing PCFS, its staff and volunteer leaders, and FSHVA from any claims I may have individually and understand that I am also releasing PCFS, its staff and volunteer leaders, and FSHVA from any claims my child or anyone else may have as a result of any injuries suffered by my child while participating and/or traveling to or from. I understand that the area where camp is held has an endemic tick population that has a heightened risk of tick-borne infections that can lead to serious illness. PCFS will provide further information in the form of an information meeting about detection and prevention of these illnesses.
I further authorize the camp nurses and staff to administer such acts of first-aid as seem necessary. Authorization is also given for appropriate staff members to transport the applicant to a doctor’s office or medical facility to secure the services of a physician. I further authorize the Camp Falling Spring staff to receive temporary physical custody of my child upon completion of any treatment. I further promise to utilize family insurance for any appropriate medical care and/or hospitalization. I understand attempts will be made to reach me in the event of a serious illness or injury.
Permission is also granted to PCFS to use audio and/or visual recordings for website, bulletin boards, and promotional purposes.
PARTICIPATION AGREEMENT: I acknowledge that participation in CFS activities involves inherent risks including, but not limited to: (1) moderate and severe personal injury, (2) property damage, (3) disability, (4) death, and (5) sickness or disease involving the participant and/or their family/or guardians, or (6) emotional injury. I accept and assume full responsibility for these risks as well as any and all other risks involved with the use of PCFS and FSHVA facilities and participation in CFS activities.
I/my child will act in a responsible way that respects the rights, safety, and dignity of all participants and agree(s) to:
- Not visit or participate if I have a fever or symptoms of illness.
If a dispute over this agreement arises, the participant (or parent/guardian) agrees to resolve the matter through a mutually acceptable alternative dispute resolution process. If the participant (or parent/guardian) and the activity sponsor cannot agree upon such a process, the dispute will be submitted to a three-member arbitration panel for resolution in accordance with the rules of the American Arbitration Association.
By signing below, I/we understand and agree to this waiver. (Click next to sign)
