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COMBINED CONSENT, PERMISSION AND RELEASES FOR PARTICIPATION IN CATHOLIC CHARITIES DIOCESE OF CLEVELAND CAMP CHRISTOPHER CAMP PROGRAMMING

1. PERMISSION FOR MEDICAL TREATMENT AND RELEASE OF LIABILITY

I hereby give permission and authorize Catholic Charities Corporation, dba Catholic Charities Diocese of Cleveland and/or Camp Christopher(hereinafter “CCDC”), their agents, employees and assigns to provide medical care including but not limited to the administration of prescribed medications and the delivery of first aid care to me or to the program member for whom I am parent or legal guardian (hereinafter “the program member”). I hereby give permission and authorize CCDC, their agents, employees, successors and assigns to act on my behalf or on the behalf of the program member to seek medical treatment in the case of illness or accident from a medical practitioner or hospital and to arrange necessary related medical transportation. Should medical attention be required to care for me or for the program member, I agree to pay any expenses incurred.

In consideration of my participation or the participation of the program member in a CCDC program, and wishing to promote and benefit this non-profit cause, on behalf of myself and the program member, I hereby release, indemnify, hold harmless and defend CCDC, the Diocese of Cleveland Facilities Services Corporation, the Catholic Diocese of Cleveland and the Bishop of the Catholic Diocese of Cleveland, and any of their officers, agents, servants, representatives , employees, licensees, successors and assigns from any and all liability for claims and demands arising out my medical care or the medical care of me and/or the program member. I, on behalf of myself and the program member, specifically waive any rights and claims that I and/or the program member may have as well as any other claims for damages in law or equity.

2. PERMISSION TO PARTICIPATE IN FIELD TRIPS AND RELEASE OF LIABILITY

I hereby give permission and authorize Catholic Charities Corporation, dba Catholic Charities Diocese of Cleveland (hereinafter CCDC), their agents, employees, successors and assigns to include me or the program member for whom I am parent or legal guardian (hereinafter “the program member”) in any and all travel and/or field trips offered by CCDC throughout the term of the program. I am aware that travel of any kind, whether by vehicle, foot, or any other means, constitutes a field trip. I understand that it is my responsibility to ascertain my physical fitness or the physical fitness of the program member to participate in any and all field trips of the program.

In consideration of my participation or the participation of the program member in a CCDC program, and wishing to promote and benefit this non-profit cause, on behalf of myself and the program member , I hereby indemnify, hold harmless and defend CCDC, the Diocese of Cleveland Facilities Services Corporation, the Catholic Diocese of Cleveland and the Bishop of the Catholic Diocese of Cleveland, and any of their officers, agents, servants, representatives , employees, licensees, successors and assigns from any and all liability for claims and demands arising out of my participation or the participation of the program member in any field trips. I specifically waive any rights and claims for damages in law or equity on behalf of myself and the program member.

3. PERMISSION TO PARTICIPATE IN ACTIVITIES AND/OR USE SWIMMING POOL AND LAKES AND RELEASE OF LIABILITY

I hereby give consent for me or for the program member for whom I am parent or legal guardian (hereinafter “the program member”) to participate in activities at, near or in the lakes at Camp Christopher while participating in CCDC programs at Camp Christopher.

As a parent or guardian of the program member, I recognize and acknowledge that there are certain risks of injury involved in activities at, near or in a body of water, and the program member and I agree to assume the full risk of any and all injuries, including loss of life, damages or other losses that I or the program member might sustain as a result of the program member’s participation in activities at, near or in the lakes at Camp Christopher, while participating in CCDC programming at Camp Christopher. 

In consideration of being permitted or of the program member being permitted to participate in activities at, near or in the lakes of Camp Christopher, while the program member participates in CCDC programming at Camp Christopher, I agree on my behalf and on the behalf of the program member, to waive and relinquish all claims and to fully release and discharge and agree to the extent permitted by law, to indemnify, hold harmless and defend CCDC, the Diocese of Cleveland Facilities Services Corporation, the Catholic Diocese of Cleveland and the Bishop of the Catholic Diocese of Cleveland, and any of their officers, agents, servants, representatives , employees, licensees, successors and assigns from any and all claims resulting from injuries, including loss of life, damages or other losses including but not limited to the administration of emergency medical treatment, for injuries sustained by me and/or the program member arising out of, connected with or in any way associated with participation in the activities at, near or in the lakes at Camp Christopher while the program member participates in CCDC programming at Camp Christopher.

4. PERMISSION TO PARTICIPATE IN EQUINE ACTIVITIES AND RELEASE OF LIABILITY

I hereby give consent for me or the program member for whom I am parent or legal guardian (hereinafter “the program member”) to participate in equine activities, including those associated with the Catholic Charities Corporation, dba Catholic Charities Diocese of Cleveland and/or Camp Christopher, (hereinafter CCDC) Horseback Riding Program, and knowingly and willingly assume on behalf of myself and the program member all inherent risks of equine activities and harm resulting therefrom, including the injury or death of the program member, whether caused by the negligence of CCCS or any other cause.

I understand, acknowledge, and agree that there is always an inherent risk of harm, including injury, death, or loss to person or property, associated with equine activities, whether working around, riding, and/or merely being a spectator observing equines, and that Ohio law grants CCDC immunity from liability in damages in a tort or other civil action for any harm sustained by me or by the program member during an equine activity and resulting from an “inherent risk of an equine activity” under certain circumstances. See O.R.C. 2305.321. I further understand and acknowledge that “inherent risk of an equine activity” refers to a danger or condition that is an integral part of an equine activity, including, but not limited to:

(a) The propensity of an equine to behave in ways that may result in injury, death, or loss to persons on or around the equine;

(b) The unpredictability of an equine’s reaction to sounds, sudden movement, unfamiliar objects, persons, or other animals;

(c) Hazards, including, but not limited to, surface or subsurface conditions;

(d) A collision with another equine, another animal, a person, or an object;

(e) The potential of an equine activity participant to act in a negligent manner that may contribute to injury, death or loss to the person of the participant or to other persons, including, but not limited to, failing to maintain control over an equine or failing to act within the ability of the participant.

By way of example, and not by limitation, additional risks associated with equine activities include the failure or breaking of tack, being mounted on a horse or other equine which proves to be ill-matched to a rider’s ability, dangerous latent conditions on, near, or off the property, falling or being thrown from a horse or other equine, being kicked or bitten by a horse or other equine, being stepped on or run into by a horse or other equine, striking a protruding or overhanging object while mounted, or being dragged as a result of the rider’s foot slipping through a stirrup and becoming lodged therein.

I further understand and acknowledge that I or the program member may be riding and controlling a horse by his/herself (i.e., not led on a lead rope) and may be riding in a riding ring, along a road, in a field, and/or in a forest on a trail ride, among other places. I also understand and acknowledge that no warranties or representations of any kind have been made by CCDC regarding the disposition, temperament, training, or health of the horses or other equines used in the Horseback Riding Program.

 In consideration for me and/or for the program member being permitting to enter Camp Christopher and to participate in equine activities, including, but not limited to, riding, exercising, handling, grooming, tacking, and otherwise working with or being around equines, on behalf of myself and the program member, I agree to waive and relinquish all claims and to fully release and discharge and agree to the extent permitted by law, to indemnify, hold harmless and defendCCDC, dba Catholic Charities Diocese of Cleveland and/or Camp Christopher, Diocese of Cleveland Facilities Services Corporation, the Catholic Diocese of Cleveland and the Bishop of the Catholic Diocese of Cleveland, and any of their officers, agents, servants, representatives , employees, licensees, successors and assigns from any and all claims resulting from injuries, including loss of life, damages or other losses including but not limited to the administration of emergency medical treatment, for injuries sustained by me and/or the program member arising out of, connected with or in any way associated with participation in equine activities at Camp Christopher.

5. PERMISSION TO PARTICIPATE IN ROPES COURSE, ZIP LINE AND ROCK CLIMBING ACTIVITIES AND RELEASE OF LIABILITY

I hereby give consent for me or the program member for whom I am parent or legal guardian (hereinafter “the program member”) to participate in both high and low ropes course activities, the zip line and rock climbing activities associated with the Catholic Charities Corporation, dba Catholic Charities Diocese of Cleveland and/or Camp Christopher (hereinafter CCDC)Camp Christopher Program, and knowingly and willingly assume all inherent risks of these activities and harm resulting therefrom on behalf of myself and the program member, including the injury or death of the program member, whether caused by the negligence of CCDC or any other cause.

I understand, acknowledge, and agree that there is always an inherent risk of harm, including injury, death, or loss to person or property, associated with ropes course, zip line and rock climbing activities. I further understand and acknowledge that these are strenuous and psychologically demanding activities and require participants to be in good physical condition. Although it is impossible to foresee all possible dangers, I understand and acknowledge that some specific risks the participant may encounter while using the ropes course, zip line and/or rock climbing activities might include, but are not limited to injury from slipping, falling, running, or jumping. I am aware and understand that a potential risk of physical injury that may not only be from my/the program member’s own actions, inactions, or negligence, but also from the actions, inactions, or negligence of others, the condition of the environment, equipment, or areas where the event or activity is being conducted. I understand and acknowledge that the programs are physically demanding and potentially dangerous. Therefore, I represent that I/the program member is free of medical or physical conditions, which might create undue risk to self or others who depend on me/the program member. I understand and acknowledge that I/the program member is responsible for behaving in a careful and prudent manner to minimize the risk of injury to self or others. I understand and acknowledge that this is a voluntary program and that I/the program member should participate to the extent that I/the program member feel is appropriate to my/the program member’s physical condition and skill level. I understand and acknowledge that I/the program member must not participate under the influence of drugs and alcohol, and agree not to participate in that Participant will not be able to participate if under the influence of drugs or alcohol.

In consideration for me and/or the program member being permitting to enter Camp Christopher and to participate in ropes course, zip line and/or rock climbing activities, on behalf of myself and the program member, I agree to waive and relinquish all claims and to fully release and discharge and agree to the extent permitted by law, to indemnify, hold harmless and defend CCDC,the Diocese of Cleveland Facilities Services Corporation, the Catholic Diocese of Cleveland and the Bishop of the Catholic Diocese of Cleveland, and any of their officers, agents, servants, representatives , employees, licensees, successors and assigns from any and all claims resulting from injuries, including loss of life, damages or other losses including but not limited to the administration of emergency medical treatment, for injuries sustained by myself and/or the program member arising out of, connected with or in any way associated with participation in ropes course, zip line and/or rock climbing activities at Camp Christopher.

6. PERMISSION TO RECORD AND USE IMAGES AND RELEASE OF LIABIITY

I hereby give permission and authorize Catholic Charities Corporation, dba Catholic Charities Diocese of Cleveland (hereinafter CCDC), their agents, employees, successors and assigns to photograph, or otherwise electronically or digitally record my image or the image of the program member for whom I am parent or legal guardian (hereinafter “the program member”) for publication in printed or electronic form, and for my image or that of the program member to be seen and disseminated to the general public in any media form, including, but not limited to CCDC newsletters, posters, displays, films, videos or websites.

In consideration of my participation or the participation of the program member in a CCDC program, and wishing to promote and benefit this non-profit cause, on behalf of myself and the program member, I hereby indemnify, hold harmless and defend CCDC, the Diocese of Cleveland Facilities Services Corporation, the Catholic Diocese of Cleveland and the Bishop of the Catholic Diocese of Cleveland, and any of their officers, agents, servants, representatives , employees, licensees, successors and assigns, from any and all liability for claims and demands arising out of the use of my image or the image of the program member in any aforementioned media. I specifically waive any rights and claims that I may have or claim for privacy, invasion of privacy, libel, payment or royalties for use of the above-described photograph, as well as any other claims for damages in law or equity on behalf of myself and the program member.

7. ACCEPTANCE OF FINANCIAL RESPONSIBILITY AND RELEASE OF LIABILITY

I pledge on behalf of myself and the program member that all of the information contained in this application is accurate, complete and true. This application has my approval on behalf of myself and the program member, and I and/or the program member, agree to abide by the rules and decisions of Catholic Charities Corporation, dba Catholic Charities Diocese of Cleveland and/or Camp Christopher(hereinafter CCDC). I accept financial responsibility for any fees associated with my participation or the participation of the program member I am enrolling. I understand that all activities at Camp Christopher have certain risks and could result in injury or death. On behalf of myself and the program member, I specifically waive and relinquish all claims that I or the program member for whom I am parent or legal guardian (hereinafter “the program member”) might have, fully release and discharge and agree to indemnify, hold harmless and defend CCDC, the Diocese of Cleveland Facilities Services Corporation, the Catholic Diocese of Cleveland and the Bishop of the Catholic Diocese of Cleveland, and any of their officers, agents, servants, representatives , employees, licensees, successors and assigns, on behalf of myself and the program member, from any and all liability for claims and demands resulting from harms or injuries, including but not limited to loss of life, damages and losses sustained by me or by the program member arising out of, connected with or in any way associated with activities of CCDC.

I have read and fully understand the contents of all the above grants of permission and releases of liability, numbered 1-7, and by my signature below, consent to the provisions of each of the Releases contained herein, collectively and individually.

IN WITNESS WHEREOF, I set my hands hereto as of the date set forth below:

Dated: July 16, 2019

 

First Participant Name

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First Participant Date of Birth*
First Participant Signature*
Second Participant Name

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Second Participant Date of Birth*
Third Participant Name

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Third Participant Date of Birth*
Fourth Participant Name

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Fifth Participant Name

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Sixth Participant Name

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Seventh Participant Name

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Eighth Participant Name

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Ninth Participant Name

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Tenth Participant Name

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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.
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