Camper Liability Release Form

CAMPER LIABILITY RELEASE FORM

WHEREAS Camper Name: ; and WHEREAS Organization Name: (hereinafter "Provider") organizes recreational and educational camping activities; and WHEREAS the undersigned desires that the camper be permitted to participate in those activities subject to the terms and conditions set forth below.

Participant Information

Emergency & Medical Information

Activity Description & Dates

Participation Start Date:    End Date:

Acknowledgment of Risk and Release

I, the undersigned, acknowledge that participation in Provider's camping and recreational activities involves inherent risks which may result in injury, illness, permanent disability, or death. I voluntarily assume all risk of loss, damage, or injury to person or property sustained while participating in or traveling to/from such activities, whether caused by the negligence of Provider or otherwise.

In consideration of being permitted to participate, I, on behalf of myself, my heirs, assigns, personal representatives and next of kin, hereby release, waive, discharge and covenant not to sue Provider, its officers, directors, employees, volunteers, agents and contractors (collectively, "Released Parties") from any and all liability, claims, demands, losses or damages on account of injury, death or damage to property, caused or alleged to be caused in whole or in part by the negligence of the Released Parties or otherwise.

I further agree to indemnify, defend and hold harmless the Released Parties from any loss, liability, damage or cost, including reasonable attorneys' fees, arising out of or related to my participation in the activities, whether caused by negligence of the Released Parties or otherwise.

I acknowledge that I have read and understand the foregoing and that I agree to be bound by its terms.

Medical Authorization

If the camper requires emergency medical treatment while under the supervision of Provider and I cannot be reached, I authorize Provider to obtain such medical care as Provider deems appropriate, including transportation to a medical facility and treatment by licensed medical personnel. I accept responsibility for costs incurred.

I authorize emergency medical treatment as described above.

Photography and Media

I grant Provider the right to photograph and record the camper during activities and to use such photographs, video or audio for promotional, educational or other lawful purposes without compensation to me.

I consent to the use of photographs and recordings as described above.

Governing Law; Severability; Entire Agreement

This Release shall be governed by and construed in accordance with the laws of the State of , without regard to conflict of law principles.

If any provision of this Release is held to be invalid or unenforceable, the remaining provisions shall remain in full force and effect. This Release constitutes the entire agreement between the parties with respect to the subject matter herein and supersedes all prior and contemporaneous agreements, representations and understandings.

Acknowledgment and Certification

I certify that I am the parent or legal guardian of the camper named above or that I am an adult camper legally capable of entering into this Release. I represent that the information provided on this form is complete and accurate to the best of my knowledge.

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