CimNaz Youth Release Form
EVENT: Senior High Camp - June 11-14, 2021 - Camp Table Rock - Shell Knob, MO
Sign in to Google to save your progress. Learn more
Participant Name *
Participant Phone Number
Address *
Parent/Guardian Name *
Parent/Guardian Phone Number *
Participant Allergies/Medical Conditions/Medications
Is the participant covered by personal/family medical insurance? *
If "YES" enter your Provider and the Group/Policy number.
I give permission to Pastor Tom Boese, Pastor Travis Janzen or other leaders, staff, or volunteers assigned by them to hospitalize, secure proper treatment for, order injections, anesthesia, or minor surgery for my child during the event in the case of a medical emergency. *
As the parent or legal guardian of said participant, I hereby grant to the Cimarron Church of the Nazarene the right to post pictures/video on Facebook, or Instagram of said participant.  I understand that once the image/video is posted it can be downloaded by anyone.  Therefore, I agree to indemnify and hold harmless Cimarron Church of the Nazarene from any claims. *
Participation Agreement
Participation Agreement
I acknowledge that participation in the activity described above involves risk to the Participant (and to Participant's parents or guardians, if Participant is a minor), and may result in various types of injury including, but not limited to, the following: sickness, bodily injury, death, emotional injury, personal injury, property damage and financial damage.

In consideration for the opportunity to participate in the event described above, the Participant (or parent/guardian if Participant is a minor) acknowledges and accepts the risks of injury associated with participation in and transportation to and from the event. The Participant (or parent/guardian) accepts personal financial responsibility for any injury or other loss sustained during the event or during transportation to and from the event, as well as for any medical treatment rendered to the Participant that is authorized by the Sponsoring Organization or its agents, employees, volunteers, or any other representatives (collectively referred to hereinafter as the "Event Sponsor"). Further, the Participant (or parent/guardian) releases and promises to indemnify, defend, and hold harmless the Event Sponsor and Sponsoring Organization for any injury arising directly or indirectly out of the described event or transportation to and from the event, whether such injury arises out of the negligence of the Event Sponsor, the Participant, the Sponsoring Organization or otherwise.

If a dispute over this agreement or any claim for damages arises, the Participant (or parent/guardian) agrees to resolve the matter through a mutually acceptable alternative dispute resolution process. If the Participant (or parent/guardian) and the Sponsoring Organization cannot agree upon such a process, the dispute will be submitted to a three-member arbitration panel for resolution pursuant to the rules of the American Arbitration Association.

By choosing "YES" both the participant and parent/guardian understand and agree with the "Participation Agreement". *
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy