Alpine Retreat Waiver

ALPINE RETREAT WAIVER

This form must be completed by ALL individuals attending Camp.
Participant's Full Name:*
First and Last
GENERAL RELEASE OF LIABILITY:
I have asked Mile High Ministries (hereinafter "Camp") to be allowed to participate in activities offered at Camp. Activities may include but are not limited to: archery, rock climbing, low ropes course, gaga ball, sports, hiking, zip line, waterfront, swimming. I acknowledge and understand that: (1) Camp activities involve physical exertion and other risks, (2) the possibility of risk of injury to individuals participating or observing the activities, including but not limited to permanent disability including blindness, or death does exist, (3) the need/requirement to participate in the activities in accordance with the rules that are given and to follow directions given by Camp staff, (4) it is my responsibility to wear any and all safety gear deemed necessary by Camp, (5) my physical and mental condition will enable me to participate safely in the activities. I waive and release any and all claims, demands, actions, causes of action and rights (contingent, accrued, inchoate, or otherwise), defend, and hold Camp harmless from and against any and all claims, liabilities, expenses, damages, losses, cause of action, and suits (including, without limitation, attorney's fees and costs) arising out of, or in any way related to my participation in activities at Camp, whether caused by Camp's active or passive negligence or otherwise.
Initials:*
IMAGE RELEASE WAIVER
I give my permission to Camp to use any photographs, video and audio of me for any promotional materials, including Camp websites and social media postings, without expectation of compensation, including, but not limited to, any royalties, proceeds, and/or other benefits derived from such photographs, videos, or audio recordings.
Initials:*
MEDICAL RELEASE WAIVER
I give Camp permission to provide or arrange necessary transportation, to secure and administer proper treatment as needed, and to release any records necessary for insurance or care purposes. Camp may also give information as necessary to all those who may be caring for me at camp.
Initials:*
INFECTIOUS & CONTAGIOUS WAIVER
The novel coronavirus (COVID-19), is no longer a worldwide pandemic but is still around. As a result, federal, state, and local governments and agencies recommend industry specific mitigation measures including but not limited to vaccination, mask wearing, increased personal hygiene practices, and modified cleansing/sanitization procedures. Camp maintains compliance with local and federal mandates to ensure guest safety, and has enacted preventative measures and programming adjustments in response. However, we cannot guarantee that you or your family members will not contract COVID-19.

By participating in programs, services, and activities at our facility, you agree to the following:

I hereby release, covenant not to sue, discharge, and hold harmless Camp, its employees, agents, and representatives, of and from all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating to your participation in our programs, services, or activities. I understand and agree that this release includes any claims based on the actions, omissions, or negligence of Camp, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any camp-hosted or programmed event.
Signature (for all 4 waivers):*

Clear
Parent/Guardian Signature if camper is a minor
Today's Date*

MonthDayYear
Date
I opt out of promotional/marketing outreach.

Page2 Participant Name
Participant's Full Name Emergency Contact
First and Last
Participant DOB (MM/DD/YYYY):*
MaleFemale
Primary Emergency Contact: Mr. Mrs. Ms. Dr.:*
Name
Relationship to Camper:*
Ex: Mother, Father, Aunt, Grandparent, etc.
Phone:*
Format: (000) 000-0000.
Email:*
example@example.com
Address:*
Secondary Emergency Contact
Secondary Emergency Contact: Mr. Mrs. Ms. Dr.:
Name
Relationship to Camper:
Ex: Mother, Father, Aunt, Grandparent, etc.
Phone:
Format: (000) 000-0000.
Email:
example@example.com
Address: (if different)
HEALTH HISTORY:
I decline to provide health information to Camp.
1. Do you have any physical limitations, conditions, or difficulties that require consideration by Camp? If so, please describe them & give instructions for accommodation (e.g. diabetes, epilepsy, mobility concerns):
YesNo
3. Date of last Tetanus booster:

MonthDayYear
Should be within the last 10 yrs., or as advised by your physician)
4. Date of last Physical:

MonthDayYear

Pg 3 Duplicated Name
ACKNOWLEDGEMENT & RELEASE OF LIABILITY
I understand that:
1. If I am dismissed from camp for any reason (e.g. illness, injury, rule/policy breaches), no amount of the fees paid to Camp shall be refunded.
2. If I am dismissed from Camp for any reason, I will vacate the premises immediately, regardless of time of day, condition, or convenience.
3. I cannot attend camp if my primary residence currently has a pest infestation (e.g. lice, bedbugs).
4. I cannot attend camp if I am recovering from a contagious condition/illness, or if I have been exposed to anindividual exhibiting symptoms of COVID-19 within the last five (5) days.
5. If I become ill, contract, or suffer from conditions/symptoms resulting from another individual unknowingly orknowingly bringing pests, infections or disease to camp, Camp is not liable.
I consent and agree to attend Camp, abide by the policies, procedures, and traditions of Camp, and to participate in the activities involved. I give my permission for Camp to assist my Group Leaders and Group Nurse in obtaining qualified medical/surgical assistance and/or to administer aid, in the event of a personal accident or my illness.
Signature*

Clear
Parent/Guardian Signature if camper is a minor
Date duplication
Should be Empty:

ALPINE RETREAT WAIVER

GENERAL RELEASE OF LIABILITY:

IMAGE RELEASE WAIVER

MEDICAL RELEASE WAIVER

INFECTIOUS & CONTAGIOUS WAIVER

Secondary Emergency Contact

HEALTH HISTORY:

ACKNOWLEDGEMENT & RELEASE OF LIABILITY