Fall Retreat 2018 Release Form

AUTHORIZATION AND RELEASE OF LIABILITY: In consideration for Park Cities Baptist Church (the “Church”) allowing me to participate in the College Ministry Fall Retreat 2018 (the “Retreat”), I, as participant, understand and agree that my participation in four-wheeling, athletic and other activities of this Retreat necessarily involve the risk of injury and even death from various causes, including but not limited to accidents, falls, strenuous and prolonged physical activity, dehydration, illness, collision or dispute with other participants, weather related injuries, terrain and equipment defects, and negligence of participants. I assume these risks and hereby release, discharge, hold harmless and indemnify, and covenant not to sue, the Church and/or its representatives/vendors including staff, employees, trustees, officers and volunteers of the Church and its representatives/vendors as to any and all claims for personal injuries I suffer, property damage, medical expenses, and economic loss arising directly or indirectly out of my participation in the Retreat and any first aid, medical care or treatment provided to me in the event I am injured or become ill while participating in Retreat activities, and excepting claims that may not be released under applicable law. This Release of Liability shall be as broadly construed as allowed by law to include all claims and rights that I may have. I am legally responsible for myself, and therefore have legal authority to release such liability, and the Church relies on my representation that I have such legal authority. If any provision of this Release of Liability is deemed invalid, the remaining provisions shall remain in full force and effect. This Release of Liability shall be binding on me, my family, heirs, next of kin, legal representatives, beneficiaries, successors and assigns. I give permission for free use of my picture in team/group photos and/or publicity materials for future the Church retreats/programs.

MEDICAL CONDITIONS: I understand that participation in the Retreat may involve strenuous and prolonged physical activity. I agree that to the best of my knowledge, I am healthy and able to participate in Retreat activities. I understand that the Church or its representatives may request health information concerning me and may ask me to undergo a medical exam. If the Church determines that I have a physical or mental condition that may affect my ability to safely and appropriately participate in Retreat activities, the Church may determine that I cannot be permitted to participate. I understand and agree that, while the Church desires that all will be able to participate, such decisions may have to be made out of concern for the best interests of my other participants.

In the event I am injured or become ill in Retreat activities, and if I am not able to make medical decisions, I hereby authorize the Church, its staff, employees, and volunteers to arrange for and consent on my behalf to emergency medical and dental care and treatment, including tests and radiological exams, and surgery, and hospital care and treatment, and to con- sent to medications for pain and other conditions as prescribed by medical personnel attending me. I am responsible for payment of any medical charges or expenses not covered by my insurance. I hereby consent that if the Church in good faith believes emergency medical and dental care and treatment is necessary, it may arrange for and consent to treatment on my behalf. I also agree to be transported for medical treatment in a vehicle driven by a Church employee, staff member or volunteer if he or she is an adult.

By signing below I am confirming that all information provided on this form is true and accurate, and that I fully agree to all statements made on this form.