AGREEMENT TO PARTICIPATE: ASSUMPTION OF RISK AND RELEASE OF LIABILITY
WHEREAS, THE UNDERSIGNED (the PARTICIPANT) wishes to be accepted for participation in all activities conducted by Camp Shiloh Lutheran Retreat Center
In consideration of, and for the right to participate in such activity by Camp Shiloh Lutheran Retreat Center, it’s Directors, Officers, Trustees, Employees, Agents, and/or Associate, I/we have and do hereby assume all of the risks and any other ordinary risk incidental to the nature of the activity. Further I/we will hold them harmless from any and all liability, actions, causes of action, debts, claims, and demands of every kind and nature whatsoever, whether for bodily injury, property damage or loss, medical bills, hospital bills, and doctor bills, or other wise, which the participant now has or which may arise from or in connection with participation in any other activities arranged for me by Camp Shiloh Lutheran Retreat Center, it’s Directors, Officers, Trustees, Employees, Agents, and/or Associates, and their heirs, executors, and administrators, successors and assigns and for all members of my family, including any minors accompanying me. I/we fully understand that my physical activity involves risk of injury. I/we also understand that my participation in any activity is entirely VOLUNTARY. I/we enter into this activity and take full responsibility for the decision to participate or not to participate and agree to follow all safety instructions.
MEDICAL AND MEDICATION AUTHORIZATION AND RELEASE
I/we hereby authorize the camp nurse or camp director to administer the medication listed on this form. If a medical emergency should arise while the above listed applicant is in attendance at Camp Shiloh, I/we hereby authorize the camp nurse or camp director to provide care to the camper and/or transport the camper to a medical facility. I/we further authorize the health care provider of the medical facility to administer necessary medical and /or surgical care upon arrival at the medical facility. I/we understand that camp officials will make a conscientious effort to locate the emergency contact listed on this document before any action will be taken. If it is not possible to locate the emergency contact listed, I/we will accept the expense of emergency medical and/or surgical treatment.
If the applicant is a minor, I/we give my authority and consent for Camp Shiloh or camp nurse to treat my child for a headache, fever, or upset stomach with the appropriate non-prescription medication excluding Aspirin and Pepto-Bismol.
By providing this digital signature, I am affirming that all of the information provided on this form is accurate and complete.