Winter Retreat 2023


WINTER RETREAT AT COLLEGE CHURCH 2023 LIABILITY FORM

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

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

3. For any and all campers entering 9th, exiting 12th, and who are in the 13th- 14th  grade years (up to 19 years of age), I GRANT PERMISSION for Camper to participate in Winter Retreat activities.

4. I, the undersigned, hereby consent to the recording and/or transmission of my image and/or voice during my attendance at Winter Retreat from February 10, 2023 through February 12, 2023. I further grant my consent to College Church of Christ 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 Winter Retreat and Winter Retreat 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 Winter Retreat and/or Winter Retreat 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 Winter Retreat and/or any Winter Retreat activity from February 10, 2023, through February 12, 2023 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 local trips to, during, and return to the camp, such as Bass Lake.

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: Winter Retreat 2023
lock iconUnique Document ID: 860049ddef01ca2a0b4c1eb649e4e2cf46b2d6a0
Timestamp Audit
January 1, 2023 12:39 am GMTWinter Retreat 2023 Uploaded by Jason Locke - jlockeca@gmail.com IP 23.29.5.180