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Black Point Beach Club Association’s Summer Kids Club-  
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Family Name
Guardian Name
Cell Phone Number
Black Point Address/Family name 
ex: 100 Black Point/ Cahill
Relationship to Black Point Address
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RELEASE AGREEMENT


THIS IS AN AGREEMENT FOR RELEASE, ASSUMPTION OF RISKS CONSENT TO MEDICAL TREATMENT AND INDEMNIFICATION. IT AFFECTS YOUR LEGAL RIGHTS.  YOU SHOULD READ IT CAREFULLY.


   In consideration of my child’s participation in the Black Point Beach Club Association’s Summer Kids Club (“Club”), I/We, for and on behalf of myself/ourselves and, as guardian(s) for and on behalf of the minor child(ren) listed above, and on behalf of myself/ourselves and my/our heirs and legal representatives, hereby release Black Point Beach Club Association, its directors, officers, employees and agents (collectively, “BPBCA:) from all loss of property liability for injury, claims, causes of action, agreements, promises, damages, judgments whatsoever, which the undersigned has or shall have, arising out of or related to my child’s participation in Club and the use of the premises and facilities of BPBCA.


   I/We am/are aware that there are risks and danger of personal injury and loss of property from participation in Club, and its activities, and I/We acknowledge that our child’s participation in Club, and its activities, is strictly voluntary and at my/our/his/her sole risk.


I/We hereby give my/our consent and permission to BPBCA to obtain on my/our/child’s behalf emergency medical treatment in case of sickness, accident, or injury and to secure such medical attention at my/our expense. I/We hereby further certify that my/our child(ren) has/have medical insurance coverage for such treatment.


I/We further agree on behalf of myself/ourselves, my/our child and my/our respective heirs and legal representatives to indemnify, hold harmless and defend BPBCA from and against and in respect of any and all loss of property, liability for injury, claims, cause of action, agreements, promises, damages, judgments, liability, loss, damage, costs, and expenses, without limitation as to the amount of claims, penalties imposed, assessments, amounts of judgements, amounts paid in settlement whatsoever, incurred and/or arising as a result of and in connection with my/our allowing my/our child/children onto BPBCA’s premises for participation in Club, and its activities, or any reason whatsoever.


I/We have had reasonable and sufficient opportunities to read and understand this entire document.  I/We knowingly and voluntarily agree to be bound by all of the terms and conditions set forth herein.  I/We represent the I/We have the actual authority to and do hereby enter into this agreement on behalf of and as an authorized agent, parent or legal guardian of any child(ren)/ward(s) listed on this agreement.  I/We have read and knowingly and voluntarily have assigned this agreement and specifically the release contained herein and further agree that no oral representations, statements or inducements have been made to me.


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BPBCA CLUB RULES


KEEP YOUR BODY TO YOURSELF

NO FIGHTING

USE APPROPRIATE LANGUAGE

LISTEN TO YOUR COUNSELORS/DIRECTORS

RESPECT CAMP PROPERTY

STAY ON CAMP PROPERTY (STAY OUT OF THE WOODS)

BE KIND

SHARE WITH OTHERS

HAVE FUN!!

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