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Carolina Creek Christian Camps
Participation Agreement & Waiver - Camp Day 2019

This form is REQUIRED FOR ALL PARTICIPANTS at Camp Day. ALL Adults over 18 should each sign the form at the bottom. Parents or Guardians of minors must list the name and Date of Birth of each child attending. If you are bringing minor children without their parents, please have their parent or guardian complete this form online at carolinacreek.org/campday to grant permission for their minor child to participate. Please either complete this form online using electronic signatures, or print, sign and bring with you to camp. (In this document Carolina Creek Christian Camps may be referred to as “the Camp.”)

CONSENT AND PERMISSION TO PARTICIPATE
I consent to participate, and to give my child permission to participate in all activities including, but not limited to, climbing, low ropes elements, high ropes elements, swimming, boating, diving, blobbing, zip lining, water toys, cliff jumping, cable park, tubing, banana boats, wakeboarding, water park, jumping pillow, archery, riflery, fishing, ball sports, and all indoor and outdoor events and activities. I understand all activities are optional and that my child or I have voluntarily agreed to participate in the events and activities of the Camp. I understand the aforementioned activities and all other events, hazards, or exposures connected with the Camp and the indoor and/or outdoor activities involve risk of harm and that accidents or illness can occur in places without medical facilities, physicians, or surgeons. I am aware of the risks and damages inherent with those activities and I knowingly and willingly assume the risk of injury.

AUTHORIZATION FOR EMERGENCY MEDICAL TREATMENT

If I, or my child, have any health conditions or complications that might increase the risk involved in participation in any activity, it is my obligation to inform the supervising staff members and abide by any modifications they require including abstaining from the activity.

In case of the illness or injury of myself or my child, the Camp will attempt to notify whoever is listed as the emergency contact person. In the event such notification is unsuccessful, I authorize the Camp to consent to any necessary X-ray examination, anesthetic, medical or surgical diagnosis or treatment, or hospital care. I hereby consent and give my permission to the Camp staff, or any attending physician, to make such decisions and to perform such medical treatments and/or surgery upon myself or my child that may, in their sole discretion, be necessary and proper under the circumstances.

GENERAL RELEASE AND WAIVER OF LIABILITY

I, on behalf of myself, my child, my legal representatives, heirs and assigns, do hereby release, acquit, discharge, and covenant to hold harmless Carolina Creek Christian Camps staff, personnel, or any of its representatives from any actions, damages, or liabilities arising out of any injuries, death or property damage, sustained during the participation in the activities of Carolina Creek Christian Camps and/or resulting from the treatments of any illness, or accident incurred by myself or my child during his/her stay, even if such injuries or damages are caused in whole or in part by the negligence (but not gross negligence or recklessness) of Carolina Creek Christian Camps staff, its officers, agents, employees, or participants.

MISCELLANEOUS PROVISIONS

I, personally, and on behalf of my child, hereby give Carolina Creek Christian Camps permission to use my and/or my child’s name, photograph, quotations, and likeness in any advertisements or promotions performed in connection with the Camp and agree that neither I, nor my child, shall be entitled to any compensation for such use.

I agree that this release, waiver, and indemnity agreement is intended to be as broad and inclusive as permitted by the laws of the state of Texas, and that if any portion of this agreement is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.

To the extent a claim asserted against a Released Party by a guest or parent shall be brought exclusively in Walker County, Texas and the laws applicable thereto shall be those of the state of Texas, not including those laws which may apply the laws of another jurisdiction. This agreement is intended to be binding upon my, and my child’s heirs, estates, executors, guardians, administrators, legal representatives, and assigns.

The parties agree that this agreement may be electronically signed. The parties agree that the electronic signatures appearing on this document are the same as handwritten signatures for the purpose of validity, enforceability, and admissibility.

Today's Date: May 22, 2019

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
I certify that I am 18 years of age or older
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Participant's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Parent / Guardian #2

First Name

Last Name
Participant's Date of Birth *
I Certify that I am 18 years of age or older
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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