IN CONSIDERATION of my and/or my child[ren] being given the opportunity to participate in any activity related in any way to Pilgrim Pines Camp and Retreat Center, Camp Squanto, East Coast Conference of the Evangelical Covenant Church, Inc. (a CT corporation), and East Coast Conference of the Evangelical Covenant Church, Inc. (a NH corporation DBA Pilgrim Pines Conference Center) (collectively “Pilgrim Pines”), including, but not limited to, indoor and/or outdoor games, swimming, vehicular transportation, boating, frisbee, drama, ropes courses, zip lines, climbing walls, ball games, camp fires, walking, running, hiking, jumping, climbing, archery, shooting range, baseball, basketball, soccer, volleyball, other sports, fishing, golfing, bounce house, carpentry, dance, knitting, painting, rocket building or any other activity connected in any way with Pilgrim Pines (hereinafter "Activities") I, for my child and for myself and his/her parents, personal representatives, assigns, heirs, and next of kin (“Releasors”) state and agree as follows:
I UNDERSTAND, ACKNOWLEDGE, AND HAVE BEEN FULLY INFORMED (a) that the Activities involve the risk of minor and/or serious injury including permanent disability, paralysis, and death, and/or property damage (the “Risks”); (b) these Risks and dangers may be caused by my child’s own actions, or inactions, the actions or inactions of others participating in the Activities, the conditions in which the Activities take place, or the negligence of the Releasees named below; and, (c) there may be other risks and social and economic losses either not known to me or not readily foreseeable at this time that may result as a direct or indirect result of the Activities; and I FULLY ACCEPT AND ASSUME ALL SUCH RISKS AND ALL RESPONSIBILITY FOR LOSSES, COSTS, AND DAMAGES I and/or my child[ren] may incur directly or indirectly as a result of my and/or the child[ren’s] participation in the Activities. The undersigned also expressly acknowledges that injuries received may be compounded or increased by negligent rescue operations or procedures of the Releasees.
I HEREBY RELEASE, WAIVE, DISCHARGE AND COVENANT NOT TO SUE (a) Pilgrim Pines, East Coast Conference of the Evangelical Covenant Church, Inc. (a CT corporation), and East Coast Conference of the Evangelical Covenant Church, Inc. (a NH corporation DBA Pilgrim Pines Conference Center) and/or its staff, members, trustees, administrators, directors, employees, workers, volunteers, agents, officers, counselors, instructors, rescue personnel, (b) the owners and lessees of premises used to conduct the Activities, (c) the owners and lessees of equipment used in the Activities, or (d) other participants, campers, or persons involved in the Activities, all of whom for the purposes herein are referenced to as "Releasees," from all liability to me and/or the child[ren] named below, to the child[ren]’s parents or next of kin, personal representatives, assigns, heirs, for any and all loss or damage, and any claim or demands therefore on account of injury to the person or property or resulting in the death to my person or of the child[ren] arising out of or related directly or indirectly to the Activities, whether caused by the negligence of the Releasees or otherwise, including negligent rescue operations.
I FURTHER AGREE that if, despite this release and waiver of liability, assumption of risk, and indemnity agreement, I, or anyone on my or the child[ren]’s behalf, makes a claim against any of the Releasees, I WILL INDEMNIFY, SAVE AND HOLD HARMLESS each of the Releasees from any litigation expenses, attorney fees, loss, liability, damage, or cost which may incur as a result of such claim, whether the claim is alleged to have been caused by the negligence of the Releasees or otherwise. Further, any claims or disputes relating to the child’s participating in the Activities shall be venued in the Cheshire County Superior Court in the State of New Hampshire, and that New Hampshire law shall govern this agreement.
I HEREBY STATE and represent that I am qualified, in good health, in proper physical condition, and of reasonable age and maturity to participate in such Activities.
I HEREBY GRANT PERMISSION for the child[ren] to participate in the Activities, and represent that each child is qualified, in good health, in proper physical condition, and of reasonable age and maturity to participate in such Activities.
I HEREBY GRANT PERMISSION for a licensed physician or other person, chosen by the leadership of Pilgrim Pines, to provide any medical emergency treatment necessary to me and/or my child[ren]. I will assume the liability for any resulting costs not covered by my health insurance.
I HEREBY AGREE that I am, for myself, and as the undersigned parent or legal guardian of the child or children identified below, am and will be fully responsible to pay for any damage to the real or personal property of Pilgrim Pines or to any other person participating in or related to the Activities, which damage is caused by the negligent or intentional acts of myself and/or my child[ren].
PERMISSION TO USE MY PHOTOGRAPH OR IMAGE OR PHOTOGRAPH OF CHILD. I hereby grant Pilgrim Pines permission to use, reproduce, publish or distribute any photographs, films, videotapes and/or sound recordings of me and/or my child[ren] for use in materials, publications, or other documents, including but not limited to a website available to the world wide web, it or they may create, without compensation to me or my child[ren].
I HAVE READ THIS RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND HAVE SIGNED FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT, ASSURANCE OR GUARANTEE BEING MADE TO ME AND INTEND MY SIGNATURE TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY AND AN ASSUMPTION OF THE DUTY TO INDEMNIFY TO THE GREATEST EXTENT ALLOWED BY LAW. I UNDERSTAND THAT I HAVE THE RIGHT TO CONSULT WITH AN ATTORNEY PRIOR TO SIGNING BELOW REGARDING THE LEGAL IMPLICATIONS OF THIS WAIVER.
Today's Date: January 15, 2019