CONTRACT, INDEMNIFICATION, RELEASE AND WAIVER
IMPORTANT: THIS IS A LEGAL DOCUMENT
PLEASE READ THIS DOCUMENT CAREFULLY BEFORE SIGNING BELOW. THIS AGREEMENT AND RELEASE INCLUDES A RELEASE OF CLAIMS. A COPY OF THIS RELEASE CAN BE USED AS IF IT WERE AN ORIGINAL.

St. Christopher’s, staff, and volunteers have done everything possible to assure that our youth have a rewarding experience so you can enjoy an activity for which you may not be skilled. We wish to inform you, however that this activity is not without risk. Certain risks are inherent in each activity and cannot be eliminated without destroying the unique character of the activity. These inherent risks are some of the same elements that contribute to the unique character of this activity and can be the cause of loss or damage to your equipment, or accidental injury, illness, or in extreme cases, permanent trauma or death. It is also possible that some participants may suffer mental anguish or trauma from the experience or their injuries. The program is not meant to frighten you or reduce your enthusiasm for this activity, but believes it is important for you to know in advance what to expect and to be informed of the inherent risks. The attached form describes some, but not all, of those risks.

In consideration of the services of the program, I agree as follows:

I am aware that trips may entail risks of injury or death to any participant. I understand the description of these inherent risks is not complete and that other unknown or unanticipated inherent risks may result in injury or death. These injuries occur more often when the participants are using drugs or alcohol or are not physically able to undertake the activity. I agree to assume and accept full responsibility for the inherent risks identified herein and those inherent risks not specifically identified including transportation to and from the activity. My participation in this activity is purely voluntary, no one is forcing me to participate, and I elect to participate in spite of and with full knowledge of the inherent risks.
I acknowledge receiving and reading the waiver Acknowledgment of Risk information sheet. I understand that it is incorporated herein and made a part of this document.

I acknowledge that engaging in this or any activity may require a degree of skill and knowledge different than other activities and that I have responsibilities as a participant. I acknowledge that the EYC has been available to more fully explain to me the nature and physical demands of this activity and the inherent risks, hazards, and dangers associated with this activity.

I agree that I am fully capable of participating in this activity. Therefore, I assume and accept full responsibility for myself, including all minor children, for bodily injury, death or loss of personal property and expenses as a result of those inherent risks and dangers identified herein and those inherent risks and dangers not specifically identified, and, as a result of ordinary negligence on the part of the church or program or of my negligence in participating in this activity. I also understand that in order to be allowed to participate in this outing and/or to receive instruction, I must give up my rights to hold the church or program liable for any harm that may result from my participation in this activity.
In consideration of being permitted to participate in the above listed outing, I agree to indemnify and hold harmless the church, staff, or volunteers from all claims, damages, losses, injuries and expenses arising out of or resulting from participation in these activities. I further agree to release, acquit and covenant not to sue the church, staff, or volunteers for all actions, causes of action, claims or damages, damages in law or remedies in equity of whatever kind, including the negligence of the church, staff, volunteers or my family, myself, or my heirs, against the church, staff, and volunteers arising out of participation in this activity.

I agree to the site of any lawsuit and the law governing any such lawsuit shall be Florida and governed by Florida law. The terms of this agreement shall continue and be in effect after the activity has ended. As liquidated damages, I hereby agree that if the church, staff, or volunteers are forced to defend any action, lawsuit or litigation by myself, my executors, or my heirs on my family’s or my behalf, my heirs or executors and I agree to pay the church, staff, and volunteers costs and attorney fees if they successfully defend such action, lawsuit or litigation. Should a court of competent jurisdiction declare any paragraph or part of this agreement unenforceable, the remaining parts or paragraphs shall remain in full force and effect. I have adequate health, disability and life insurance for my family and myself.

I hereby give permission for transportation to any medical facility or hospital and I authorize for any qualified guide or medical personnel to render necessary emergency medical care for my family or myself

By clicking Submit I, of my own free will, for my family, my minor children, my heirs and executors and myself, have read, understand, and acknowledge the risks and liability for myself, and my family in participating in the agreed activity

Youth name *
Your answer
Parent / Guardian name(s) *
Your answer
Address *
Your answer
City / State / Zip *
Your answer
Primary phone *
Your answer
Emergency contact name *
Your answer
Emergency contact primary phone *
Your answer
Do you carry medical insurance? *
Medical insurance provider *
Your answer
Medical insurance group number *
Your answer
Does the youth have any medical condition that would prevent your participation in this event? *
Does the youth have any previous experience with this activity? *
Submit
Never submit passwords through Google Forms.
This form was created inside of St. Christopher's Episcopal Church. Report Abuse - Terms of Service