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WWW.STUDENTLIFE.NET

Waiver & Release

All participants in Student Life Events must have a signed and notarized Waiver & Release Form, including
adults 19 years and older. Participants under 19 must have the authorized signature of a Parent/Guardian. This
form cannot be faxed or mailed to the Student Life office. It must be brought to registration.

Name of Church: ____________________________________________ City/State: _________________________

Name: ________________________________ Birthdate: _____/______/______ Age: ______ Sex: Male Female

Address: ________________________________________City: ___________________ State: _____ Zip: _______

Parent/Guardian: ______________________________________________ Home Phone: (___)_________________

Work/Cell Phone: (____)_______________ Email: ___________________________________________________
Camp Location (herein after “camp location”): _______________________________________________________

Event attending:
 Student Life Camp  Student Life Mission Camp  Student Life @ The Beach
 Student Life For Kids Camp  Student Staffer (Volunteer)

Please check which one best describes the attendee (more than one may apply):
 Student  Family Group Leader  Student Leader
 Adult  Youth/Children’s Minister

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, Inc., 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 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.
Assumption of Risk. I am aware of the risks associated with participation in the above event and 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.
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 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 content of these
programs. In consideration of this acknowledgement, I voluntarily have and do hereby, assume all risk associated with my (or
my child's) participation in these programs.
Student Life @ The Beach Authorization Addendum – I acknowledge that during my (or my child's) participation in Student
Life @ 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. In consideration of this
acknowledgment, I voluntarily have and do hereby, assume all risk associated with my (or my child's) participation in this
program.
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 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. For more detailed information
about the recreation programs offered at summer event locations, go to www.studentlifecamp.com and follow the specific
location Recreation Program link.

Understanding. I represent and acknowledge that I have completely read and understand this document and all its terms and all
matters referred to herein, 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 a Christian conciliation/mediation organization
for binding 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 19 years of age and older

Signature: _____________________________________________________________
If you are a Parent/Guardian of an attendee who is under 19 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 signature.

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.________________________.

Notary Public, Signature __________________________

My commission expires the _________ day of______________, A.D.______________.