Medical Release Form

2008 Date of Camp Attending: ____/____ - ____/____
Contact Phone #:_________________________________

Camp Release

We, the parents/guardians of ______________________________ (referred to in this release as “the camper”),:
a) hereby authorize the administration of any medical attention deemed necessary by the Mt. Gilead certified First Aider, and/or any licensed physician during the dates of camp indicated on this form.
b) hereby authorize the transportation of this camper to a licensed medical facility for attention as needed
c) hereby confirm/report that this camper has been immunized in accordance with the requirements for admission to school set by the California State Board of Education.
d) I give permission for my dependant to attend camp and participate in all camp activities and events. I understand that all recreational activities and attending camp, in general, have the inherent possibility of death or injury to person or property, which may result from participating in and/or observing such activities. Death, personal injury and/or property damage may also result from activities which we do not allow and may result from participating in or observing activities which are prohibited. I understand that this Title of Release constitutes a full and complete release from liability insofar as Mt. Gilead Bible Conference, Inc. is concerned, and by signing below, I hereby hold harmless the management and trustees of Mt. Gilead Bible Conference, Inc. and the camp staff (hereinafter collectively referred to as “Mt. Gilead”), of responsibility for any and all injury or damage to my child.
e) I give permission to Mt. Gilead to photograph and/or videotape my child for the end of the week video and for use in promotional material.

I understand that Mt. Gilead does not carry medical insurance on campers. I understand that medical insurance is the responsibility of the camper’s family.

(Both parent/guardian signatures please)

Mother’s/Guardian’s Signature ______________________________ Date ____/____

Father’s/Guardian’s Signature ______________________________ Date ____/____

Mt. Gilead Skate Park and BMX Track

THIS AGREEMENT CONSTITUTES AN EXPRESS CONTRACTUAL ASSUMPTION OF ALL RISKS, WAIVER OF AND RELEASE FROM ALL LIABILITY FOR ANY NEGLIGENCE AND AN INDEMNITY FOR ALL THIRD PARTY CLAIMS.
UNDER 18 YEARS (PARENT OR GUARDIAN NOT PRESENT)
     We know that skateboarding, in -line skating and bicycle riding are inherently dangerous sports and activities in which we choose to voluntarily participate at our own risk. We are aware that the usual risks, hazards and dangers of personal injury, death and disability or property damage and loss (collectively “damages”), necessarily increase when using ramps, curbs, steps, inclines or declines, or any other structure and device. We know that the risks, hazards and dangers include, but are not limited to, uncontrollable boards and bicycles, falling, jumping, landing, performing tricks, colliding with other users, staff, media personnel and spectators. We also understand that these risks, hazards and dangers are further increased when other persons, whether or not to the same level of experience or skill, are present at the same time and using the same facilities. (All of the above defined activities are collectively referred to throughout this Agreement as “the Hazardous Activities.”)
     By this agreement, it is our intention to relieve Mt. Gilead Bible Conference, Inc. of any duty to us and we do assume the entire risk of any of the Damages, which might occur during or as a result of my use of or presence at the camp. By this agreement, I also intend to release, discharge and absolve Mt. Gilead from any and all liability for any active or passive negligence whatsoever by Mt. Gilead and to waive and relinquish any expense or property damage or loss caused by any negligence of Mt. Gilead and promise not to sue or exercise any legal right to seek damages from Mt. Gilead. In consideration of utilizing the park, we agree as follows:

	1. As to my participation in any activity, including, but not limited to, the Hazardous Activities and as to any and all liability for the Damages which I may suffer or incur due to any cause whatsoever, while in the premises of the park, we hereby agree:
		a. To waive any and all claims for Damages that I may have against Mt. Gilead, its managers, employees, officers, directors,volunteers, sponsors, or any other person or company in any way associated with it; b. To release Mt. Gilead, from any and all liability for the Damages that I may suffer or incur, or that my next of kin may suffer as a result of my participation in any activity, including but not limited to Hazardous Activities while at the park; and c. To hold harmless and indemnify Mt. Gilead from any and all liability for the Damages to any third party resulting from my participation in any activity, including but not limited to, the Hazardous Activities while at the park.
	2. This waiver and release of liability and indemnification agreement (collectively referred to hereafter a s “Waiver and Release”) shall be effective and binding upon my heirs, next of kin, family, relatives, guardians, conservators, executors, administrators, trustees and assigns in the event of my injury, disability or death.
	3. We have read, understand and agree to be bound by the Rules of Safety/Conduct governing my conduct while using the Skate Park. We understand that these rules are strictly enforced.

Any dispute, controversy, or claim arising out of this Agreement or the interpretation of this Agreement shall be settled by arbitration in accordance with the Rules of the American Arbitration Association, except to the extent modified below. The place of arbitration shall be Sonoma County, California. The award of the arbitrator (the “Award”) shall be final and binding upon the parties and any court of competent jurisdictions may enter judgment upon the award. The arbitrator shall be required to determine all issues in accordance with substantive law of the state of California. The rules of evidence applicable to proceedings at law in the state of California shall be applicable to the arbitration proceeding.

NOTICE: BY SIGNING BELOW, THE UNDERSIGNED IS AGREEING TO HAVE ANY CLAIM DECIDED BY NEUTRAL ARBITRATION AND IS GIVING UP THE RIGHT TO A JURY OR COURT TRIAL.
     The undersigned further AGREES that this Agreement is intended to be as broad and inclusive as is permitted by the law of the state of California and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.
     The undersigned further certifies that he/she has no medical condition that would cause participation in activities at the Parks to be potentially hazardous to his or her health. In addition, this Agreement shall constitute authorization for the Parks to provide or cause to be provided such medical treatment to the undersigned as may be necessary or appropriate if an injury occurs while at the skate park.
     THE UNDERSIGNED HAS READ AND VOLUNTARILY SIGNS THIS AGREEMENT, and further agrees that no oral representations, statements, or inducements apart from this Agreement have been made by Mt. Gilead or anyone else with regard to the subject matter of this Agreement.
     My parent or legal guardian and I hereby certify that I am under 18 years old. We have completely read and understand this Agreement and its terms. Prior to signing this Agreement, we have had the opportunity to ask any questions about this Agreement, Mt. Gilead and the Skate Park. We are aware that, by signing this Agreement, we assume all risks and waive and release certain rights that I and my heirs, next of kin, family, relatives, guardians, executors, administrators, trustees and assigns may have against Mt. Gilead.

Please Initial the Following:

:	_______ I give permission to Mt. Gilead to transport my child via bus to any camp sponsored activity.
	_______ I give permission for my child to ride on the Mt. Gilead BMX track (subject to terms and conditions set forth above).
	_______ I give permission for my child to go on the Mt. Gilead Skate Park (subject to terms and conditions set forth above).
	_______ I have read and understand the terms set forth above.

Parent/legal guardian signature ______________________________ Date ____/____