REGISTRATION AND WAIVER OF RESPONSIBILITY & LIABILITY

 

Name of Activity: 2016 College Group Retreat

Location: Summit Lake Christian Camp (7610 Hampton Valley Road, Emmitsburg, MD 21727)

Date(s): 2/12/16 – 2/14/16

Cost: $85

I acknowledge that certain physical activities or trainings have inherent risks and am aware that these are uniquely present in this activity. Without limiting the generality of the foregoing statement, I specifically assume the risk of the activity I am participating in.

 I indemnify, hold harmless, and promise not to sue Hope Chapel or its Affiliates mentioned in this activity from any and all liabilities or claims made as a result of participation in this activity or event, whether caused by the negligence of release or otherwise. 

I consent Hope Chapel and its Representatives to assign me for medical treatment or hospitalization, as if such is determined necessary by a medical doctor. In doing so, I give permission for attending physician(s) and other medical personnel to administer any needed medical treatment, including surgery and I agree to pay all fees and costs arising from this action to obtain medical treatment. 

I CERTIFY THAT I HAVE READ THIS DOCUMENT, AND I FULLY UNDERSTAND ITS CONTENT. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT AND I SIGN IT OF MY OWN FREE WILL.

(Full Name)
Date of Birth *
Date of Birth
Today's Date *
Today's Date
(List a minimun of 2 contact persons for in a case of emergency in the following format: NAME, RELATIONSHIP, PHONE NUMBER)

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