Winter Youth Retreat 2019: Release Form

 
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Winter Youth Retreat 2018
Liability & Medical Release Form

Contact Information
Enter your Date of Birth
Location
Health Information
Emergency Contact Information
Person to notify if above contact cannot be reached

I, the person listed on this form, certify that I will voluntarily participate in the event listed above with the American Baptist Churches of Los Angeles and the American Congregations of the Southwest and Hawaii. I understand that all participants are expected to abide by the Program rules and be directly responsible to their church leader. The Event Director assumes responsibility for discipline at the Program and, if necessary, may, because of misconduct or disobedience, require a participant to leave. In such instance, I will assume full responsibility for returning home.

Further, I do release and hereby agree to hold blameless American Baptist Church of Los Angeles, American Congregations of the Southwest and Hawaii and its employees and agents from any and every claim arising, or which may be asserted by me or by any member of my family by reason of participating in any activities associated with the American Baptist Churches of Los Angeles. I also release the lessor/owner of properties on which the Program is held. I agree to pay for any damages or property loss as determined by American Baptist Churches of Los Angeles, American Baptist Congregations of the Southwest and Hawaii, American Baptist Churches of Los Angeles, Southwest and Hawaii or the event officials, including any keys not returned at the time of group check out.

Further, I do authorize the minister or sponsor of this activity or any American Baptist Churches of Los Angeles staff member, in the event my emergency contacts cannot be reached, I give consent to a physician and/or hospital for emergency medical or surgical treatment while on this trip. It is understood that I will assume any financial responsibility for any expense that may be incurred for said emergency treatment.

Further, I do certify that I am covered by adequate accident insurance. My consent and signature is given below. I have read and agree to the information given in this entire form.

I, as the parent and/or legal guardian of the participant listed on this form, certify that the person named on this form has my full approval to participate in the event listed above with the American Baptist Churches of Los Angeles and the American Congregations of the Southwest and Hawaii. The individual identified on this form understands that all participants are expected to abide by the Program rules and be directly responsible to their church leader. The Event Director assumes responsibility for discipline at the Program and, if necessary, may, because of misconduct or disobedience, require a participant to leave. In such instance, I will assume full responsibility for returning the participant home.

Further, I do release and hereby agree to hold blameless American Baptist Church of Los Angeles, American Congregations of the Southwest and Hawaii and its employees and agents from any and every claim arising, or which may be asserted by me or by any member of my family by reason of participating in any activities associated with the American Baptist Churches of Los Angeles. I also release the lessor/owner of properties on which the Program is held. I agree to pay for any damages or property loss as determined by American Baptist Churches of Los Angeles, American Baptist Congregations of the Southwest and Hawaii, American Baptist Churches of Los Angeles, Southwest and Hawaii or the event officials, including any keys not returned at the time of group check out.

Further, I do authorize the minister or sponsor of this activity or any American Baptist Churches of Los Angeles staff member, in the event I cannot be reached by phone, to give consent to a physician and/or hospital for emergency medical or surgical treatment while on this trip. It is understood that I will assume any financial responsibility for any expense that may be incurred for said emergency treatment.

Further, I do certify that said participant is covered by adequate accident insurance. My consent and signature is given below. I have read and agree to the information given in this entire form.