HELPING PEOPLE KNOW CHRIST THROUGH HIS WORD Name of Church: City/State:

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1 Please note, the second page of this document must be signed and notarized. FOR OFFICE USE ONLY Code: Team: AQU BLU ORG YLW GRN HELPING PEOPLE KNOW CHRIST THROUGH HIS WORD Waiver & Release ALL participants in Student Life events must have a signed and notarized Waiver and Release form. This includes participating campers, adults 18 years and older, and children of adult leaders. Participants under 18 must have the authorized signature of a Parent/Guardian. Return this form to your group leader--they are responsible for submission. Name of Church: City/State: Name: Birthdate: / / Age: Sex: Male Female Address: City: State: Zip: Parent/Guardian: Home Phone: ( ) Work/Cell Phone: ( ) Camp Location (herein after camp location ): Event attending: Student Life Camp Student Life Mission Camp Student The Beach Student Life For Kids Camp Student Staffer (Volunteer) Student Life Urban Serve Please check which one best describes the attendee (more than one may apply): Camper Adult Child of Adult Leader Consideration. I acknowledge the personal benefits accruing to me (and my child, as applicable) by reason of participation in the above described event and am aware of the activities in which I, or my child, will be involved through said participation. Release / Indemnification. I hereby, in consideration of such benefits and other good and valuable consideration received, consent to the above listed participation and release absolutely, forever discharge, hold harmless and covenant not to sue Student Life, a ministry of LifeWay, and camp location (including colleges, universities and conference centers), its directors, employees, agents, volunteers, and affiliates ("Student Life" and camp location ) from any and all present or future liability, claims, demands, actions or rights of action, whether asserted by me or a third party arising out of my (or my child's) participation in event activities (the "Claims"). I agree to indemnify and hold harmless Student Life and camp location for any such Claims brought by me or a third party from any costs associated with defending or litigating such claims, including but not limited to attorney fees, costs and legal expenses. Medical Emergency. In the event of injury or a medical emergency, I understand that the church s group leader, not Student Life and camp location, will be responsible for the medical care of all attendees. It will be the church group leader's responsibility to assess medical needs, obtain and consent to appropriate medical care, transport persons in need of medical care and contact parents or guardians of minors. I release Student Life and camp location from any and all liability related to medical treatment. In addition, I assume the risk and financial responsibility for any injury resulting from the attendee s participation in all Student Life and camp location events. Missions Authorization Addendum I acknowledge that during my (or my child s) participation in Mission Camp, Urban Serve or as a Student Staffer volunteer that certain risks do exist. These include, but are not limited to, the hazards of being in a construction type setting, travel by automobile, the risks involved in leading recreation games and those existing because of consent of these programs. Student The Beach Authorization Addendum I acknowledge that during my (or my child s) participation in Student The Beach that certain risks do exist. These include, but are not limited to, the hazards of public beaches, travel by automobile or shuttle service, public condos and hotels, recreation activities and swimming in the ocean. Camp Location Recreation Addendum - The recreation programs at summer event locations strive to offer fun, safe, and challenging activities that engage the whole person--body, mind and soul. Program staffs are trained and as a team committed to your rewarding

2 experience with safety as their highest priority. They have done everything possible to mitigate any risks involved in their recreation programs. However there are inherent risks to participation in recreation activities, including but not limited to, initiative games, high and low challenge course, outdoor education, paintball and aquatics. You could experience any of the following - elevated heart and respiratory rates, uncomfortable group dynamics, climbing or descending unpredictable and possibly slick or uneven terrain, crossing narrow wires and logs, jumping, running, climbing/descending steep rock faces, traveling long distances in remote settings, carrying weight on your backs and shoulders, unforeseen forces of nature or weather, any of which could result in injury/illness that could result in loss of life, limb, and/or property. Assumption of Risk. I am aware of the risks associated with participation in any of the above event sand do hereby voluntarily assume full responsibility for any risk of loss, property damage or personal injury, including death, that may result from participation in event activities. Understanding. I represent and acknowledge that I have completely read and understand this document and all its terms and all matters referred to herein, and I signed voluntarily as my free act and deed, that I have had an ample opportunity to obtain the advice of counsel and that, by signing this document, I understand that I am relinquishing legal rights and remedies that may have otherwise been available to me. I understand that this Waiver and Release shall be construed as broadly and inclusively as is permitted by applicable law and agree that if any portion of this document is held invalid, the remaining shall continue in full force and effect. To the extent the restriction on filing lawsuits is deemed unlawful, I agree to submit any Claims to Peacemaker International, a Christian mediation/arbitration organization for final resolution. Media Consent. I give my consent and permission for the taking of photographs and/or video of me (or my child) during the described event and waive and/or assign any and all rights (including copyright) in such media to Student Life and camp location. Student Life and camp location, as the sole owners of such media, shall have the exclusive right to control and determine the use, display, performance, reproduction and dissemination of any such photographs and/or videos. Copy to Camp Location. It is understood and agreed that a copy of this form shall be treated as authentic and binding as the original and that a copy of same shall be provided to camp location. CAUTION: READ THIS DOCUMENT CAREFULLY BEFORE SIGNING. THIS IS A GENERAL RELEASE AND INDEMNIFICATION OF CLAIMS. Please check, which applies: Parent/Guardian Attendee 18 years of age and older Signature: If you are a Parent/Guardian of an attendee who is under 18 years of age, please include the following. Your Name: Relationship to Attendee: Contact Number: Notary Information The following is to be completed by the notary witnessing parent/guardian s or adult s signature. All participants, including adults and children of adult leaders, must submit a notarized Waiver and Release before participating in camp activities. The State of the County of Before me, a Notary Public, on this day personally appeared known to me to be the person whose name is subscribed to the foregoing instrument and acknowledged to me that he executed the same for the purpose and consideration therein expressed. Given under my hand and the seal of the office this day of, A.D.. My commission expires the day of, A.D.. Notary Public, Signature Please place notary stamp or seal here if applicable for your state.

3 PARTICIPANT AGREEMENT FOR RELEASE AND ASSUMPTION OF RISK (MINOR PARTICIPANT) Please read this document carefully. It provides important information about the activities at Glorieta 2.0 and affects your legal rights and those of your child in the event that your child suffers a personal or bodily injury or other loss arising from his or her participation in activities or from being on the premises of the Camp.... I certify that I am the parent or legal guardian of ( my child ), and that I am signing this Participant Agreement on behalf of my child. In consideration of my child being permitted to participate in activities of Glorieta 2.0, use its facilities, or visit its premises for any purpose, I acknowledge and agree to the following: Activities: I understand and acknowledge that activities of Glorieta 2.0 in which my child may participate, on the premises of the Camp or elsewhere, may include, among others, the following: kayaking, canoeing, swimming, hiking, backpacking, archery and riflery, fishing, volleyball, basketball and other playground and gym games, rock climbing, rappelling, exploring caves (spelunking), zip lining, participating in paint ball games, mountain boarding (riding down dirt and loose-rock inclines), and riding mountain scooters (not motorized) and mountain bikes. As a participant, my child may also engage in competitions involving running, swimming, cycling, and other activities organized by the Camp or by others using the campgrounds and facilities. My child agrees to abide by rules and regulations of the Camp and to follow instructions of staff. Risks of Activities and Premises: I understand and acknowledge that, whether my child is supervised or not, there are risks associated with the activities of the Camp and moving about its premises and other activity sites. These risks include the following: those ordinarily associated with rigorous outdoor activities, including the unpredictable forces of nature; rugged and sometimes unstable terrain; a remote environment that may cause significant delays in obtaining emergency medical care; falls, breaks, and sprains; contact with harmful plants and animals; vehicle collisions and accidents; drowning and neardrowning; errors in judgment and conduct, including negligence, of staff, co-participants, and others; the failure of gear and equipment; and other risks of property damage, bodily injury, and death. I understand and acknowledge that some of these risks are inherent in the activities and the premises and, without undertaking these risks, the Camp experience would lose its value and appeal. Assumption of Risks: On behalf of my child, I acknowledge and assume all risks of the activities of Glorieta 2.0, wherever they may take place, and all risks of my child being on and moving about the premises of Glorieta 2.0 and any other sites of its activities. On behalf of my child, I acknowledge and assume all risks whether or not the particular risk has been described in the paragraph above and whether or not the particular risk is inherent in the activities undertaken or the premises. I have explained the risks to my child and my child understands them and chooses to participate in the activities and use the Camp and other facilities and premises in spite of such risks. RELEASE: ON BEHALF OF MY CHILD, I AGREE TO WAIVE, RELEASE, AND NOT TO SUE GLORIETA 2.0, ITS OWNERS, DIRECTORS, OFFICERS, AGENTS, AND STAFF (EMPLOYEES AND VOLUNTEERS) ( RELEASED PARTIES ) FOR ANY PROPERTY LOSS, PERSONAL OR BODILY INJURY, OR DEATH SUFFERED BY MY CHILD THAT IS IN ANY WAY RELATED TO HIS OR HER ENROLLMENT OR PARTICPATION IN ANY ACTIVITIES OF GLORIETA 2.0 OR HIS OR HER PRESENCE ON THE PREMISES OF GLORIETA 2.0 OR ANY OTHER ACTIVITY SITE. Initials

4 PARTICIPANT AGREEEMENT Page 2 Indemnity: On behalf of my child, I further agree to indemnify and hold harmless (that is, to protect and defend, and pay demands and judgments, including costs and reasonable attorneys fees) the Released Parties from any claim of property loss, personal or bodily injury, or death suffered by my child that is in any way related to his or her enrollment or participation in any activities of Glorieta 2.0 or my child s presence on the premises of Glorieta 2.0 or any other activity site. THESE AGREEEMENTS OF RELEASE AND INDEMNITY INCLUDE CLAIMS OF NEGLIGENCE BY ANY RELEASED PARTY BUT NOT CLAIMS OF RECKLESSNESS OR INTENTIONALLY WRONGFUL CONDUCT. Other: On behalf of my child, I agree to the terms of this Participant Agreement and agree that the protections it provides to the released and indemnified parties are intended to be as broad and inclusive as permitted by New Mexico law. I hereby consent to Glorieta 2.0 taking or using any photographs of my child or recording my child, whether audio or video, while he or she is on the premises of Glorieta 2.0 or any other activity site. I agree that Glorieta 2.0 may use any such photographs or recordings of my child without providing any compensation or remuneration. Glorieta 2.0 is authorized to provide or obtain medical care for my child, as it deems appropriate or necessary, and to exchange medical information about my child with any third-party care providers. To the extent a claim asserted by me or my child against a Released Party is dismissed or deemed by a court of competent jurisdiction to be without merit, I agree that the Released Party may recover from me or my child his or her costs, including reasonable attorneys fees, incurred in defending the claim. I acknowledge and agree that any suit that I or my child brings against a Released Party shall be brought exclusively in Santa Fe County, New Mexico, and that the laws applicable thereto shall be those of the State of New Mexico without regard to any conflict of law principles. This Participant Agreement may be amended only by a written instrument signed by a duly authorized representative of Glorieta 2.0. Should a court of competent jurisdiction find any provision of this Participant Agreement to be invalid, illegal, or unenforceable, on behalf of my child, I agree that the remainder of this Participant Agreement shall nevertheless remain in full force and effect. I acknowledge and agree that this Agreement is intended to be binding upon me and my child and my child s heirs, estate, executors, guardians, administrators, legal representatives, and assigns. Signature: Printed Name: Date:

5 Effective January 1, 2015 to December 31, 2015 Name: Address: Phone: M F Age: Birthday: / / Grade: School: Mother s Name: Work Phone: Cell Phone: Father s Name: Work Phone: Cell Phone: Emergency Contact (other than parent) Name: Work Phone: Cell Phone: Doctor s Name and Phone Number: List any known allergies or frequent health issues List any medications currently taking (prescription* and/or over the counter) and dosage: *Prescription medication must be in proper packaging with pharmacy label and doctor s name List any major injuries and/or surgeries in the last five (5) years: Date of last tetanus shot: Any swimming restrictions? Any activity restrictions? Insurance Company: Group #: Policy#: Insurance Phone Number:

6 Effective January 1, 2015 to December 31, 2015 Consent Form, Medical, and Liability Release & Waiver I. I/We the undersigned have legal custody of, a minor, and have given our consent for him/her to attend events being organized by The Fellowship. I/We understand that there are inherent risks involved in any ministry or athletic event, and I/WE HEREBY ASSUME ALL RISKS, KNOWN AND UNKNOWN, AND RELEASE THE FELLOWSHIP, ITS PASTORS, EMPLOYEES, AGENTS, REPRESENTATIVES, AND VOLUNTEER WORKERS FROM ANY AND ALL LIABILITY for any injury, loss, or damage to person or property that may occur during the course of my/our child s involvement. II. III. IV. In the event that he/she is injured and requires the attention of a doctor, I/WE CONSENT TO ANY REASONABLE MEDICAL TREATMENT AS DEEMED NECESSARY by a licensed physician; including, but not limited to: hospitalization, securing medical treatment, or ordering an injection, anesthesia, or surgery for my child as deemed necessary. I/We, the parent or legal guardian of the above named student, understand that THE FELLOWSHIP CARRIES NO MEDICAL OR HOSPITALIZATION COVERAGE FOR PARTICIPANTS IN THIS PROGRAM. In the event treatment is required from a physician and/or hospital personnel, I/We agree to hold THE FELLOWSHIP, its pastors, employees, agents, representatives, and volunteer workers free and harmless of any claims, demands, or suits for damages arising from the giving of such consent. I/WE ALSO ACKNOWLEDGE THAT WE WILL BE ULTIMATELY RESPONSIBLE FOR THE COST OF ANY MEDICAL CARE should the cost of that medical care not be reimbursed by the health insurance provider of the participant s parents or legal guardians. V. I/we affirm that the HEALTH INSURANCE INFORMATION PROVIDED ABOVE IS ACCURATE at this date and will, to the best of my/our knowledge, still be in force for the student named above. VI. VII. VIII. I/We also agree to bring my/our child home AT MY/OUR OWN EXPENSE should they become ill or if deemed necessary by a member of THE FELLOWSHIP staff. I do hereby agree to hold THE FELLOWSHIP, its pastors, employees, agents, representatives, and volunteer workers HARMLESS OF ANY LIABILITY, ACTIONS, CAUSES OF ACTIONS, CLAIMS, EXPENSES AND DAMAGES ON ACCOUNT OF INJURY TO MY CHILD, PROPERTY, EVEN INJURY RESULTING IN DEATH, WHICH I NOW HAVE OR WHICH MAY ARISE IN THE FUTURE IN CONNECTION with the activity or participation in any other associated activities. Furthermore, I GIVE MY CONSENT AND PERMISSION FOR THE FELLOWSHIP TO CAPTURE AUDIO AND VISUAL FOOTAGE OF ME (OR MY CHILD) during the event and waive and/or assign any and all rights (including, but not limited to copyright) in such media to THE FELLOWSHIP. THE FELLOWSHIP, AS THE SOLE OWNERS OF SUCH MEDIA, SHALL HAVE THE EXCLUSIVE RIGHT to control and determine the use, display, performance, reproduction and dissemination of any such audio and visual footage. Signature of Participant Date Signature of Parent (Required, even if STUDENT is 18 or older) Date