Release and Disclosure Form
Assumption of Risk, Liability Release, and Indemnity Agreement
The below mentioned participant (“Participant”) desires to participate in camp related activities, including physically demanding and potentially dangerous activities, including but not limited to games, recreation, camping, swimming, boating, hiking, a ropes course, a climbing wall, and other activities of which the Participant and/or Legal Guardian have been made aware, as well as travel by vehicle or on foot (collectively the “Activities”), sponsored by, connected with, or related to Five Star Life, Inc. and Summit Life, Inc., which are Indiana nonprofit corporations.
In consideration for being permitted to participate in the Activities on Day Trip and Camp Dates, the Participant and Legal Guardian (“Releasors”) agree as follows:
The Releasors understand that not all dangers and hazards with respect to the Activities can be foreseen or eliminated. Furthermore, the Releasors are aware that certain risks exist in these Activities that are beyond the control of the organization and its staff. The Releasors have or will investigate and do assume all risks involved with such participation in the Activities, including personal or bodily injury (e.g. cuts, scrapes, bruises, fractures, debilitating injuries, diseases contracted from insects or otherwise, and other injury), death, or property damage.
Having understood the aforementioned demands and risks associated with the Activities, including unforeseen risks, the Releasors hereby waive, release, and forever discharge Five Star Life, Inc. and Summit Life Inc., and their respective directors, officers, employees, volunteers, agents, successors and assigns (the “Released Parties”) from any and all claims, damages, costs or expenses of any kind arising out of or related to the Participant’s attendance or participation in the Activities, including those caused by the Released Parties’ negligence, other participants’ negligence, or otherwise. The Releasors understand that this document is a full and complete release of all claims for personal or bodily injury and property damage which the Participant might sustain as a result of such attendance and/or participation in the Activities regardless of the specific cause thereof, and the Releasors understand that in the event of such personal or bodily injury, death, or property damage, the Participant, his/her representatives, assignees, insurer, heirs, executor, spouse, next of kin, and the Releasors cannot and will not seek any type of recovery or reimbursement whatsoever from the Released Parties. Further, the Releasors agree to indemnify and hold harmless the Released Parties from any liability, loss, or damage, including attorney’s fees, which may arise due to the Participant’s participation in the Activities.
The Releasors expressly agree that this Assumption of Risk, Liability Release, and Indemnity Agreement (herein referred to as the “Agreement”) is intended to be construed under the laws of the state of Indiana, and that it is intended to be as broad and inclusive as permitted by the laws of Indiana and that if any term of this Agreement is held illegal, invalid, or otherwise incapable of being enforced, such term shall be excluded to the extent of such invalidity or unenforceability; all other terms hereof shall remain in full force and effect; and, to the extent permitted and possible, the invalid or unenforceable term shall be deemed replaced by a term that is valid and enforceable and that comes closest to expressing the intention of such invalid or unenforceable term.
The parties agree that any claim or dispute arising from or related to this Agreement shall be settled by biblically based mediation and, if necessary, legally binding arbitration in accordance with the Rules of Procedure for Christian Conciliation of the Institute for Christian Conciliation, a division of Peacemaker Ministries (complete text of the rules are available at http://peacemaker.net/rules-of-procedure/). Judgment upon an arbitration decision may be entered in any court otherwise having jurisdiction. The parties understand that these methods shall be the sole remedy for any controversy or claim arising out of this Agreement and expressly waive their right to file a lawsuit in any civil court against one another for such disputes, except to enforce an arbitration decision.
I HAVE CAREFULLY READ THIS AGREEMENT AND ANY ADDENDUMS.
I UNDERSTAND THAT I ASSUME ALL RISKS INHERENT AND UNFORESEEN RISKS, AS WELL AS THOSE RISKS SET FORTH IN THIS AGREEMENT.
I UNDERSTAND THAT THIS AGREEMENT IS A RELEASE OF ALL CLAIMS, INCLUDING THOSE DUE TO THE NEGLIGENCE OF THE RELEASED PARTIES AND OF OTHER
I UNDERSTAND THAT I AM INDEMNIFYING THE RELEASED PARTIES.
I CERTIFY THAT I AM  AT LEAST EIGHTEEN (18) YEARS OLD, OR  THE LEGAL GUARDIAN ACTING ON BEHALF OF THE PARTICIPANT WHO IS UNDER THE AGE OF EIGHTEEN (18) YEARS OLD.
I VOLUNTAIRLY SIGN MY NAME EVIDENCING MY UNDERSTANDING AND ACCEPTANCE OF THE PROVISIONS OF THIS AGREEMENT.