February 28th - March 2nd
Dream Mountain Christian Camp - Murphys, CA
We, the undersigned parents/guardians of the above-named participant, grant permission for the participant to participate in Community Bible Church Unafraid Winter Camp from February 28th, 2025, through March 2nd, 2025, with exceptions listed below. We, as parents or guardians, have been advised of the nature and extent of the activities that may take place and represent to you that the participant is physically and mentally able to participate in those activities. We have also been advised that we are able to cancel the consent and release prior to the end of the specified time.
The above-named participant is NOT permitted to participate in the following activities that have been marked:
We understand that in the unlikely event medical intervention is needed, every attempt will be made to contact the persons listed on this form. In the event I cannot be reached in an emergency, I hereby give permission to the physician selected by the activity leader to hospitalize, to secure medical treatment and/or to order an injection, anesthesia, or surgery for my child as deemed necessary. I understand that my insurance coverage for my child will be used as primary coverage in the event medical intervention is needed. Coverage by Community Bible Church through its accident policy will be used as a backup for what my family’s insurance does not cover.
I authorize the Community Bible Church to furnish any necessary transportation, food, and lodging for this participant.
I UNDERSTAND AND HERBY AGREE TO ASSUME ALL OF THE RISKS WHICH MAY BE ENCOUNTERED ON SAID ACTIVITIES, INCLUDING ACTIVITIES PRELIMINARY AND SUBSEQUENT THERETO. I do, for myself and for my child, heirs and assigns, hereby irrevocably and unconditionally release, acquit, and forever discharge the Community Bible Church and its agents, employees, and volunteers from any and all liability, actions, causes of actions, claims, expenses, obligations and damages of any nature whatsoever, which I now have or which may arise in the future, in connection with my child’s participation in the described activity or in any other associated activities including, but not limited to, any injury to my child or property, even injury resulting in death. I understand that transportation may be provided by church bus, church van, rental vehicles, adult leader vehicles, etc. I expressly agree that this release, waiver, and indemnity agreement is intended to be broad and inclusive as permitted by the law of the State of California and that if any portion hereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. This release contains the entire agreement between the parties hereto.
I further state that I HAVE CAREFULLY READ AND UNDERSTAND THE FOREGOING RELEASE AND KNOW THE CONTENTS HEREOF AND I SIGN THIS RELEASE AS MY OWN FREE ACT. I understand that this is a legally binding agreement.
MEDIA WAIVER I consent to the use of any video images, photographs, audio recordings, or any other visual or audio reproduction that may be taken of the youth during the activities attended by them to be used or shown, as CBC deems appropriate.
By signing the form below you, the Guardian of the Student listed above, are acknowledging that you have read and understand all conditions.
