2021 SCCC Liability Form


SUMMER CAMP AT COLLEGE CHURCH 2021 LIABILITY FORM

1. Camper’s participation in SCCC and SCCC activities is completely voluntary;

2. Certain SCCC activities involve the risk of injury, which may be significant, and, while particular rules, supervision, and other steps may reduce this risk, the risk or serious injury does exist;

3. For any and all campers entering 9th and exiting 12th grade, I GRANT PERMISSION for Camper to participate in SCCC and SCCC activities, including a trip to Bass Lake on Wednesday July 21, 2021, and I further GRANT PERMISSION for Camper to ride to and from Bass Lake in a private car and to participate in water sports involving a boat, paddle board, kayak, and/or other equipment or vehicles on the water;

4. I, the undersigned, hereby consent to the recording and/or transmission of my image and/or voice during my attendance at Summer Camp at College Church (SCCCC) from July 18, 2021 through July 23, 2021. I further grant my consent to College Church of Christ and/or Mountain Valley Community Church to use, reuse, transmit, exhibit, and/or publish my appearance, in whole or in part, without restriction and without compensation now and in the future for promotional, artistic, or other purposes;

5. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown and including ALL RISKS THAT MAY RESULT FROM ANY ACT OF NEGLIGENCE ON THE PART OF College Church of Christ, any of their agents and/or employees AND ALL OTHER RELEASEES, as set forth below, and assume full responsibility for Camper’s participation in SCCC and SCCC activities;

6. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS College Church of Christ, their officers, officials, agents, and/or employees (“Releasees”) WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to any person or property, WHETHER ARISING FROM ANY ACT OF NEGLIGENCE OF College Church of Christ, any of their agents and/or employees OR OTHER RELEASEES, to the fullest extent permitted by law;

7. I further agree to INDEMNIFY AND HOLD HARMLESS AND RELEASE College Church of Christ, any of their agents and/or employees OR OTHER RELEASEES from any loss, liability, damage or cost, including court costs and attorneys’ fees that may accrue related to Camper’s participation in SCCC and/or SCCC activities, whether caused by negligence or release or otherwise; and

8. If any part of this Assumption of Risk and Release of Liability is found invalid, the remaining portions remain valid, enforceable, and in effect to the fullest extent permitted by law.

I consent to use my electronic signature in lieu of an original signature on paper. I understand that I have the right to request signing a paper copy instead. By checking here, I waive that right. I understand that I may obtain a paper copy of an electronic record upon written request to College Church of Christ, C/O Jason Locke at 1284 E. Bullard, Fresno CA 93710. No fee will be charged for such copy and no special hardware or software will be required to view it. My agreement to use an electronic signature for any document will continue until such time as I notify [recipients] in writing that I no longer with to use an electronic signature. There is no penalty for withdrawing consent. I will make sure that [recipients] have a current email address in order to contact me regarding any changes, if necessary.

CONSENT TO MEDICAL TREATMENT

(“Camper”) do hereby authorize College Church of Christ, and any agent or employee acting on its/their behalf (“Church”), as the organization/s to whom my child is entrusted, TO CONSENT TO any X-ray examination, anesthetic, medical, surgical treatment and/or hospital care to be rendered to the above named minor under general or special supervision and upon the advice of a physician, surgeon, or dentist licensed under the laws of the State of California. IN GIVING THIS CONSENT, I RECOGNIZE AND UNDERSTAND that in the above such situations I will not be able to knowledgeably evaluate and choose among the available alternative treatments or procedures, if any, or to evaluate risks attendant upon each, and the risks attendant to foregoing all treatment. In such situations, I authorize a physician, surgeon, or dentist to exercise his/her professional judgment and assess the risks incident to and choose the necessary treatment from any available alternative and to render such care and perform such treatment as in his/her professional judgment, determines to be necessary for the health or safety of Camper. This authorization will remain effective while Camper is in route to and/or from, involved in or participating in SCCC and/or any SCCC activity from July 18 2021, through July 23 2021 unless revoked in writing by the undersigned, and delivered to College Church of Christ C/O Jason Locke at 1284 E. Bullard, Fresno CA 93710. Said authorizations will also remain in effect throughout a trip to Bass Lake on July 21, 2021.

I consent to use my electronic signature in lieu of an original signature on paper. I understand that I have the right to request signing a paper copy instead. By checking here, I waive that right. I understand that I may obtain a paper copy of an electronic record upon written request to College Church of Christ C/O Jason Locke, 1284 E Bullard, Fresno CA 93710. No fee will be charged for such copy and no special hardware or software will be required to view it. My agreement to use an electronic signature for any document will continue until such time as I notify College Church of Christ C/O Jason Locke, 1284 E Bullard, Fresno CA 93710 in writing that I no longer with to use an electronic signature. There is no penalty for withdrawing consent. I will make sure that College Church of Christ C/O Jason Locke, 1284 E Bullard, Fresno CA 93710 have a current email address in order to contact me regarding any changes, if necessary.

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Signature Certificate
Document name: 2021 SCCC Liability Form
lock iconUnique Document ID: 9939979a3a364f5c3b5ac5fd5b55c4c7c809f3ca
Timestamp Audit
May 19, 2021 7:49 pm GMT2021 SCCC Liability Form Uploaded by Jason Locke - jlockeca@gmail.com IP 76.217.188.77