Covenant City Church Release Form
Church Activity Liability Release Form and Emergency and Medical Information
Event name/location: Covenant City Church Retreat / Camp JIM 1026 Camp Jim Rd SW, Pillager, MN 56473
Event date:8/26/22-8/28/22
Cost: $92 for 7+; $56 for 4yrs – 6yrs
*3yrs and younger are free.
To pay for the retreat online, please go HERE and select RETREAT. You can also pay via check or cash. If paying by check, please make it out to Covenant City Church with RETREAT as the memo. If paying by cash, please put it in an envelope with your name and the word RETREAT. Both check and cash can be deposited into the giving box.
*FOOD IS INCLUDED IN THE COST
In consideration for being accepted by Covenant City Church for participation in the above event, we (I), being 21 years of age or older, do for ourselves (myself) [and for and on behalf of my child-participant if said child is not 21 years of age or older] do hereby release, forever discharge and agree to hold harmless Covenant City Church and its officers or staffs or co-workers thereof from any and all liability, claims or demands for personal injury, sickness or death, as well as property damages and expenses, of any nature whatsoever which may be incurred by the undersigned and the child-participant that occur while said child is participating in the above event. Further authorization and permission is hereby given to said church to furnish any necessary transportation, food and lodging for this participant. Further, we (I) [and on behalf of my child-participant if said child if under the age of 21 years] hereby assume all risk of personal injury, sickness, death, damage and expenses as a result of participation in work activities and recreation involved in the event therein. The undersigned further hereby agrees to hold harmless and indemnify said church, its officers, staff and co-workers for any liability sustained by said church as the result of negligent, willful or intentional acts of said participant, including expenses incurred attendant thereto.
For participant under age of 21 years: We are (I am) the parents or legal guardian of this participant. In case of emergency and if family physician can not be reached, We (I) hereby give our (my) permission to take said participant to a Certified Emergency Personnel (i.e. EMT, doctor or hospital) and hereby authorize medical treatment, including but not limited to emergency surgery or medical treatment, and assume the responsibility of all medical bill, if any. Further, should it be necessary for the participant to return home due to medical reasons, disciplinary action or otherwise, we (I) hereby assume all transportation costs. We (I) grant full permission for organizers to use photographs, portraits, films, and videos of this participant from this event. By signing below, we (I) acknowledge that we (I) have read and understand the above and accept the conditions contained herein. We (I) also represent with signature below that by signing on behalf of the child participant indicated below, we are (I am) the legal guardian of the said child.
Church Activity Liability Release Form and Emergency and Medical Information
Event name/location: Covenant City Church Retreat / Camp JIM 1026 Camp Jim Rd SW, Pillager, MN 56473
Event date:8/26/22-8/28/22
Cost: $92 for 7+; $56 for 4yrs – 6yrs
*3yrs and younger are free.
To pay for the retreat online, please go HERE and select RETREAT. You can also pay via check or cash. If paying by check, please make it out to Covenant City Church with RETREAT as the memo. If paying by cash, please put it in an envelope with your name and the word RETREAT. Both check and cash can be deposited into the giving box.
*FOOD IS INCLUDED IN THE COST
In consideration for being accepted by Covenant City Church for participation in the above event, we (I), being 21 years of age or older, do for ourselves (myself) [and for and on behalf of my child-participant if said child is not 21 years of age or older] do hereby release, forever discharge and agree to hold harmless Covenant City Church and its officers or staffs or co-workers thereof from any and all liability, claims or demands for personal injury, sickness or death, as well as property damages and expenses, of any nature whatsoever which may be incurred by the undersigned and the child-participant that occur while said child is participating in the above event. Further authorization and permission is hereby given to said church to furnish any necessary transportation, food and lodging for this participant. Further, we (I) [and on behalf of my child-participant if said child if under the age of 21 years] hereby assume all risk of personal injury, sickness, death, damage and expenses as a result of participation in work activities and recreation involved in the event therein. The undersigned further hereby agrees to hold harmless and indemnify said church, its officers, staff and co-workers for any liability sustained by said church as the result of negligent, willful or intentional acts of said participant, including expenses incurred attendant thereto.
For participant under age of 21 years: We are (I am) the parents or legal guardian of this participant. In case of emergency and if family physician can not be reached, We (I) hereby give our (my) permission to take said participant to a Certified Emergency Personnel (i.e. EMT, doctor or hospital) and hereby authorize medical treatment, including but not limited to emergency surgery or medical treatment, and assume the responsibility of all medical bill, if any. Further, should it be necessary for the participant to return home due to medical reasons, disciplinary action or otherwise, we (I) hereby assume all transportation costs. We (I) grant full permission for organizers to use photographs, portraits, films, and videos of this participant from this event. By signing below, we (I) acknowledge that we (I) have read and understand the above and accept the conditions contained herein. We (I) also represent with signature below that by signing on behalf of the child participant indicated below, we are (I am) the legal guardian of the said child.