707 Fall Retreat Release Form 2021

Name of student attending Winter Retreat *

First Name Last Name

INSURANCE COMPANY *

INSURANCE POLICY # *

UNDER NAME OF: *

Relationship to student: *

OPC MILFORD Staff is allowed to give my student over the counter medications for minor ailments. *

Yes No

Oak Pointe Church Participation Release *

In case of medical emergency or general medical care, I give consent for medical treatment for my child named above by authorized personnel. I certify the above child has my permission to attend the Fall Retreat Nov 5-7, 2021 with the Oak Pointe Church High School Ministry. I will not hold Oak Pointe Church or Miracle Camp responsible for any injuries my child encounters during the weekend. I understand that transportation is not provided by Oak Pointe and I must arrange my childs transportation to and from camp. If my child behaves in a way that the camp staff feels is destructive or detrimental to the safety or enjoyment of the campers, I understand that my child can be sent home at my expense.

Please read this agreement CAREFULLY before signing. If the participant is a minor (under the age of 18), all documents must also be signed by either a parent or legal guardian. All references to “Participant” are deemed to include the parent or legal guardian of any participant who is a minor or the entire participating family in case of a family camp or retreat. It is expressly agreed by Participant that Miracle Camp & Retreat Center (“MCRC”) shall not be held liable for any losses of personal property or for any bodily injuries, or the results thereof, incurred and suffered by the Participant on any property of MCRC or in connection with any activities or programs of MCRC. Participant expressly agrees to release, defend, indemnify, and hold MCRC and its directors, officers, staff, and agents (“Representatives”) harmless against any and all claims, demands, damages, costs or attorney’s fees, rights of action, or causes of action, of any person or entity, that may arise from injuries or damages sustained by the Participant during or as a result of his or her participation in activities at MCRC. MCRC program activities may include but are not limited to hatchet throwing; BB guns and trap shooting; archery; water activities, including but not limited to tubing, blobs, water slides, and water trampolines; initiative courses and games; ropes courses; climbing and bouldering towers and walls; zip lines; paintball; hayrides; miniature golf; snow activities, including but not limited to tobogganing and snowshoeing; bonfires; outdoors activities including but not limited to hiking, and camping; indoor and outdoor field and playground games; and riding in a MCRC vehicle or boat. The purpose of the program is to provide participants with safe, challenging, experiential activities which require problem solving, decision making, self and group awareness, trust, cooperation, and care and consideration of others. The activities will be selected considering the program objectives that have been predetermined by MCRC staff and leaders from the Participant’s organization. Unless otherwise expressly indicated in writing by parent or legal guardian of Participant, Participant may engage in any activity at MCRC. By signing this form, the Participant acknowledges that certain elements of the program are physically and emotionally demanding, and that not all hazards and dangers associated with the activities can be foreseen. The Participant understands and acknowledges that certain risks, dangers, and injuries, including fatalities and serious bodily injuries, acts of God, inclement weather, slipping, falling, insect bites, equipment failure and other circumstances inherent to outdoor settings may exist in the program’s activities. The Participant also understands and agrees that it is impossible for MCRC to guarantee absolute safety. The Participant understands and voluntarily assumes all such risks, dangers, and injuries associated with participation in this program, including the provision of medical treatment, and agrees that neither MCRC nor its Representatives in any capacity shall be liable for any loss, damages, or injuries resulting to the Participant by acts of negligence, breach of contract, strict liability, or otherwise. The Participant further agrees to release, defend, indemnify, and hold MCRC and its Representatives harmless from or for any claims, causes or action, liabilities, or damages that may arise resulting from or in connection with his/her participation in the program. The Participant expressly releases and agrees to release, defend, indemnify, and hold harmless MCRC and its Representatives from any claims, causes or action, liabilities, or damages to persons or property, to the fullest extent of the law, that may arise in any way related to transportation that may be chartered or otherwise arranged by MCRC through a third-party company. The Participant understands and acknowledges that transportation to MCRC is not a part of MCRC programs and MCRC retains no control over any third-party transportation company. The Participant is responsible to comply with any rules instituted by a third-party transportation provider. The Participant understands and agrees that MCRC is not liable for any damage, loss, or theft that may occur to the Participant’s vehicle while it is parked at MCRC or at any location related to chartered transportation. The Participant is responsible to comply with any parking or traffic laws and is solely responsible for any related costs. The Participant understands and acknowledges that participation in MCRC’s programs and activities is completely voluntary. The Participant expressly agrees to obey all of the program safety regulations and direction by the program’s leaders. The Participant voluntarily assumes and accepts responsibility for all risks, dangers, and injuries resulting from either his/her failure to obey safety regulations and directions of activity leaders or from the exercise of judgment by such activity leaders made in good faith based on then existing circumstances. By signing this form, the Participant acknowledges that he/she has read and understands the above Participant Agreement/Acknowledgment and Release Form. The Participant’s signature(s) on this document is also intended to bind his/her/their successors, heirs, representatives, administrators, and assigns. In the event the Participant is required to defend or indemnify MCRC, MCRC shall retain the right to control the defense and selection of counsel, except that the Participant must agree to any monetary settlement. The Participant assumes responsibility for restricting any activities agreed upon and listed above. The Participant assumes full responsibility for Participant’s health and certifies that Participant is free of or will notify his/her instructor of any medical, physical, or emotional conditions which might create undue risk for Participant or others. Participant will exercise good judgment regarding his/her health, safety, and well-being while participating in the program. If for any reason Participant questions his/her ability to participate in the activity, Participant will notify his/her instructor prior to participation. The Participant hereby grants permission to the medical personnel selected by the camp director, program director, or other leadership staff to order x-rays, routine tests, hospitalize, secure proper treatment for, and to order injection and/or anesthesia and/or surgery for participant. The Participant also grants permission for medical personnel to obtain access to necessary medical, psychiatric, or social work records from MCRC to the extent necessary for appropriate medical treatment. The Participant understands and agrees that MCRC does not assume any responsibility or obligation to provide financial assistance in the event of injury or illness and that Participant is responsible for all costs related to the provision of medical treatment or emergency care. The Participant certifies that photographs and videotape pictures of Participant engaging in camp activities may be used in promotional materials for the camp. By signing this form, Participant gives permission for MCRC to send emails regarding upcoming events and news (we will not sell your information). This form may be photocopied for use out of camp.a question

Release and Indemnification Agreement *

*

PARENT/GUARDIAN SIGNATURE *

Clear

PARENT/LEGAL GUARDIAN NAME *

First Name Last Name

PARENT/LEGAL GUARDIAN PHONE NUMBER *

Area Code Phone Number

Date *

Date