to mission beach in san diego, ca
PARTICIPATION AGREEMENT I acknowledge that participation in the activity described above involves risk to the Participant and may result in various types of injury.
TO MISSION BEACH IN SAN DIEGO, CA JULY 31 - AUGUST 1
CHARTERED BUS DEPARTING FRIDAY 11:00 PM (Check in at 9:00 pm) RETURNING SATURDAY AT MIDNIGHT $80 PER STUDENT | If you are a student that served at RISE camp, you can receive the discounted cost of $20. • Cost includes transportation, breakfast and dinner • Lunch will be on your own with a group
PERMISSION SLIPS & MONEY MUST BE TURNED BY TUESDAY, JULY 28!
participant ___________________________________________________________ birth date _________________________________
o guy o girl
phone ________________________________
address _____________________________________________________________________________ parent/guardian ______________________________________________________________________ parent’s phone ___________________________
parent’s email ____________________________
Is sponsor authorized to approve medical treatment? Is participant covered by personal/family medical insurance?
o Yes o No o Yes o No
If yes, name of insurance co. ___________________________________________________________ name of insured _____________________________________________________________________ policy or group # _____________________________________________________________________ emergency contact ____________________________________________________________________ emergency contact phones: ____________________________________________________________
signature ______________________________________________________
date ________________
signature _____________________________________________ ________
date _________________
In consideration for the opportunity to participate in this Event, the Participant (or Participant’s parent/guardian if Participant is a minor) acknowledges and accepts the risks of injury associated with participation in and transportation to and from this Event. The Participant (or Participant’s parent/guardian) accepts personal financial responsibility for any injury or other loss sustained during this Event or during transportation to and from the activity, as well as for any medical treatment rendered to the Participant that is authorized by the Sponsor or its agents or any other representatives. Further, the Participant (or parent/guardian) releases and promises to indemnify, defend, and hold harmless the Event Sponsor for any injury arising directly or indirectly out of the described Activityor transportation to and fromthis Event, whether such injury arises out of negligence of the Event Sponsor, the Participant, 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 th Event Sponsor 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.
PHOTOGRAPH RELEASE The Participant (or Participant’s parent/ guardian if Participant is a minor) consents to and authorizes the use and reproduction of any and all photographs taken of the Participant. The Participant (or Participant’s parent/ guardian if Participant is a minor) hereby releases, discharges and holds harmless North Phoenix Baptist Church and hereby waives any right to approve the finished photograph or any copy that might beused in conjunction with the finished photograph.
TO MISSION BEACH IN SAN DIEGO, CA JULY 31 - AUGUST 1
CHARTERED BUS DEPARTING FRIDAY 11:00 PM (Check in at 9:00 pm) RETURNING SATURDAY AT MIDNIGHT $80 PER STUDENT | If you are a student that served at RISE camp, you can receive the discounted cost of $20. • Cost includes transportation, breakfast and dinner • Lunch will be on your own with a group
PERMISSION SLIPS & MONEY MUST BE TURNED BY TUESDAY, JULY 28!
participant ___________________________________________________________ birth date _________________________________
o guy o girl
phone ________________________________
address _____________________________________________________________________________ parent/guardian ______________________________________________________________________ parent’s phone ___________________________
parent’s email ____________________________
Is sponsor authorized to approve medical treatment? Is participant covered by personal/family medical insurance?
o Yes o No o Yes o No
If yes, name of insurance co. ___________________________________________________________ name of insured _____________________________________________________________________ policy or group # _____________________________________________________________________ emergency contact ____________________________________________________________________ emergency contact phones: ____________________________________________________________
signature ______________________________________________________
date ________________
signature _____________________________________________ ________
date _________________
In consideration for the opportunity to participate in this Event, the Participant (or Participant’s parent/guardian if Participant is a minor) acknowledges and accepts the risks of injury associated with participation in and transportation to and from this Event. The Participant (or Participant’s parent/guardian) accepts personal financial responsibility for any injury or other loss sustained during this Event or during transportation to and from the activity, as well as for any medical treatment rendered to the Participant that is authorized by the Sponsor or its agents or any other representatives. Further, the Participant (or parent/guardian) releases and promises to indemnify, defend, and hold harmless the Event Sponsor for any injury arising directly or indirectly out of the described Activityor transportation to and fromthis Event, whether such injury arises out of negligence of the Event Sponsor, the Participant, 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 th Event Sponsor 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.
PHOTOGRAPH RELEASE The Participant (or Participant’s parent/ guardian if Participant is a minor) consents to and authorizes the use and reproduction of any and all photographs taken of the Participant. The Participant (or Participant’s parent/ guardian if Participant is a minor) hereby releases, discharges and holds harmless North Phoenix Baptist Church and hereby waives any right to approve the finished photograph or any copy that might beused in conjunction with the finished photograph.
