Name(s) of Children
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Please list all children attending Champ Camp, as well as their age and school year in 2017-2018
Release & Indemnity Agreement
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In consideration of my participation in this activity, I hereby release and discharge Bluemont Church from any and all liability arising from accident, injury and illness that I may suffer as a result of participation in such activity. I further agree to indemnify and hold harmless Bluemont Church staff and its volunteers from any and all claims resulting from injuries, damages, and losses sustained by me arising out of, connected with, or in any way associated with the activity. In the event of an emergency, I authorize Bluemont Church to secure from any licensed hospital, physician or medical personnel any treatment deemed necessary for my immediate care and agree that I will be responsible for payment of any and all medical services rendered. If any damage to facilities, equipment or materials occurs as a result of misuse by me during use, I will be responsible for payment of any repairs and/or replacement needed. Also, the undersigned authorizes Bluemont Church to use at its discretion any photograph(s) taken of participants while participating for marketing in print or by electronic means.
