Young Life Guest Consent Release Form
For Outside Groups Using Young Life Camp

Section I: INDEMNITY AND CONTRACT AGREEMENT

I will not hold or attempt to hold Young Life liable for any loss, damage or injury to person or property caused by any act or neglect of other persons on or about the Property, or caused in any manner other than the willful or negligent act of Young Life, its agents and employees, and will indemnify and hold Young Life harmless from any liability for damages or claims against Young Life arising out of or in any way related to any such loss, damage or injury. I release Young Life, including its trustees, employees and agents, from my physical injury, including death, or illness while at the Property. I will assume the risk associated therewith, whether known or unknown to me at this time. This release is also intended to include all claims of my family, estate, heirs, personal representatives or assigns.

Section II: AUTHORIZATION FOR TREATMENT

I hereby give permission to the medical personnel selected by the camp director to secure and administer treatment and to maintain and/or release any medical records necessary for insurance purposes as outlined under the HIPAA regulation, and to provide or arrange necessary related transportation for the above named person.

To obtain a copy of Young Life’s Notice of Privacy Practices, log on to www.younglife.org or call (719) 867-3600.

I verify that I am or my child is in good health and am capable of participating in strenuous activities, and when necessary, will tailor my activities to those within the bounds of my physical health.

In Colorado, campers will participate in rigorous activities at 9,000 to 14,000 feet. I recognize that any medical treatment and/or medical transportation that is provided to me or my child while attending a Young Life camp will be paid for by my medical insurance company.

Section III: COVID-19

I recognize that a national emergency was declared because of the COVID-19 outbreak and that different states and/or counties/cities may be in various states of emergency. I recognize that even if Young Life has taken reasonable actions in light of COVID-19 and other coronaviruses, there is no guarantee that me or my child will not contract/transmit COVID-19 or other infectious or contagious illnesses or diseases while participating in activities and events at the Young Life property/camp, or traveling to and from, Young Life’s camp property and I release Young Life in the event of such an occurrence.

The Center for Disease Control (CDC) has identified that certain individuals are at Higher Risk for Severe Illness if they become ill with COVID-19. This includes those who have chronic lung disease, moderate/severe asthma, a serious heart condition, are immunocompromised, or have severe obesity, diabetes, or chronic kidney/liver disease or who are over the age of 65. Based on the CDC’s High-Risk criteria, you have determined if you want to participate in this event or if you want your child to participate in this event.

Section IV: WAIVER AND RELEASE

If I am under the age of 18, or under the age of 19 if attending Malibu Club or Beyond Malibu, my parent or guardian, by signing below, also consent to my release and he or she agrees that this release shall be binding upon him or her as my parent or guardian as to me and my estate, heirs, personal representatives and assigns. My parent or guardian also promises, by signing below to defend, indemnify and hold Young Life harmless from any claim asserted by me against Young Life, including its trustees, employees and agents, if I should repudiate this release after obtaining adulthood.

Charlotte Christian School Release of Liability Form

BY SIGNING BELOW I AM INDICATING THE FOLLOWING:

We understand that the student must abide by the expectations and standards outlined in the Charlotte Christian Family Handbook both before and during the trip. These expectations include policies on academics, behavior and attendance. A student’s failure to abide by these policies at any time may affect their ability to go on the trip. The school reserves the right to remove a student from a trip before or during the trip for failing to meet these expectations. If a student is removed from the trip or sent home during the trip, the family is responsible for covering the cost of travel and will not receive a refund.

Students are responsible to self-carry any emergency medication. Students taking a scheduled medication during the trip must have the medication documented on the Medication Authorization form. The student and/or a parent must make their trip chaperone aware of any medical conditions and medications that the student may have.

CONSENT TO TREAT

The parent/guardian set forth in this form does hereby authorize a chaperone of the school to see that my child receives any emergency medical treatment that may become reasonably necessary while said student is on this trip. Payment of all charges incurred for medical treatment is guaranteed by the parent. Every effort will be made to contact parents/guardians in advance of treatment, by telephone, in case of injury or illness. The parent/guardian set forth in this form does hereby agree to hold harmless the person appointed as well as Charlotte Christian School and the physician providing treatment from and against any and all loss, costs, damage or expense of any kind arising out of or in connection with that person’s or physician’s acting in reliance upon the authorization set forth herein, with the exception of actions which amount to gross negligence.

PERMISSION AND RELEASE OF LIABILITY

I give my permission for my student to participate in the trip indicated above. I understand that although the students will be supervised by a CCS employee, I do assume the risk in my student’s participation in the trip.

I acknowledge that I will not seek to have Charlotte Christian School held liable in the event that any accident, injury, loss of property or any other circumstance or incident occurs during or as a result of my son’s/daughter’s participation in the trip. This release of liability includes accident, injury, loss, or damages to the student, as well as, to other individuals or property which may result from the student’s participation in the trip. I hereby release and agree to hold harmless Charlotte Christian School, its officials, agents and employees, from any claims arising out of my son’s/daughter’s participation in the event(s).

I have read and understand and accept all of the statements recited above and accept full responsibility as described.

DIGITAL SIGNATURE ACKNOWLEDGMENT

Electronic Signature (eSignature): You consent and agree that your use of a keypad, mouse or other device to select an item, button, icon or similar act/action while using any electronic form we offer; or in accessing or making any transactions regarding any document, agreement, acknowledgment, consent, term, disclosure, or condition constitutes your signature, acceptance and agreement as if actually signed by you in writing. Further, you agree that no certification authority or other third-party verification is necessary to validate your electronic signature; and that the lack of such certification or third-party verification will not in any way affect the enforceability of your signature or resulting contract between you and Charlotte Christian School. You understand and agree that your eSignature executed in conjunction with the electronic submission of your form will be legally binding and such transaction will be considered authorized by you.