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    Camp Indemnity Form-2

    Uploaded by

    skhangezilemo

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Camp Indemnity Form-2

    Uploaded by

    skhangezilemo
    7 views1 page

    Copyright

    © © All Rights Reserved

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    PDF, TXT or read online from Scribd

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    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    7 views1 page

    Camp Indemnity Form-2

    Uploaded by

    skhangezilemo

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    You are on page 1of 1

    Event Indemnity Form

    Event Name: _______________________________ Event Dates: __________ to ______________

    Event Venue: _______________________________

    Full Name: ______________________________________________________________________________________________

    Contact No: _______________________________ Address: ___________________________________________________

    ________________________________________________________________________________________________________

    Young Life Area: ____________________________________ School: _______________________________________________

    Leader Name: ______________________________________ D.O.B: ________________________________________________

    Medical Information: Please list below any medical conditions that you have which we might need to be aware of, prepare for
    and take into considerations when doing our activities.(Examples would be: Heart problems, Epilepsy, Diabetes, etc.) Also add
    any food allergies as well. This information is to assist us in our preparedness only and will not be divulged to any third party.

    ________________________________________________________________________________________________________

    ________________________________________________________________________________________________________

    Parent/Guardian Name:____________________________________________________________________________________

    Relationship: ______________________________________________________ Cell: __________________________________

    E mail: __________________________________ Parent/Guardian Signature: ____________________________________

    INDEMNITY AND CONTRACT AGREEMENT: I will not hold or attempt to hold Young Life liable for any loss, damage or injury to
    person or property caused by any act or neglect of other persons on or about the Campsite Property, or caused in any manner
    other than the willful or negligent act of Young Life, its volunteers and employees, and will indemnify and hold Young Life
    harmless from any liability for damages or claims against Young Life arising out of or in any way related to any such loss,
    damage or injury. I release Young Life, including its trustees, employees and volunteers, from my physical injury, including
    death, or illness while at the campsite or on the way there. I will assume the risk associated therewith, whether known or
    unknown to me at this time. This release is also intended to include all claims of my family, estate, heirs, personal
    representatives or assigns.

    Authorization for Treatment: I hereby give permission to the medical personnel selected by the camp director to secure and
    administer treatment and to maintain and/or release any medical records necessary, and to provide or arrange necessary
    related transportation for the above named person. I verify that I am in good health and am capable of participating in
    strenuous activities, and when necessary, will tailor my activities to those within the bounds of my physical health.

    WAIVER AND RELEASE: IF I AM UNDER AGE 18, MY PARENT OR GUARDIAN, BY SIGNING ABOVE, ALSO CONSENTS TO MY
    RELEASE AND HE OR SHE AGREES THAT THIS RELEASE SHALL BE BINDING UPON HIM OR HER AS MY PARENT OR GUARDIAN AS
    TO ME AND MY ESTATE, HEIRS, PERSONAL REPRESENTATIVES AND ASSIGNS. MY PARENT OR GUARDIAN ALSO PROMISES, BY
    SIGNING BELOW TO DEFEND, INDEMNIFY AND HOLD YOUNG LIFE HARMLESS FROM ANY CLAIM ASSERTED BY ME AGAINST
    YOUNG LIFE, INCLUDING ITS TRUSTEES, EMPLOYEES AND VOLUNTEERS, IF I SHOULD REPUDIATE THIS RELEASE AFTER
    OBTAINING ADULTHOOD.

    Signature___________________________________________________ Date:________________________________________

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