St. Crispin's Waiver

St. Crispin’s Episcopal Conference Center Release, Indemnity & Medical Treatment Authorization

Group Name*

Name of Participant(s)*

Please Print Adult and/or Child(s) Name(s)

I am aware that during my child’s*/my stay at St. Crispin’s Episcopal Conference Center (referred to as St. Crispin’s), my child*/I may encounter certain risks and dangers. These risks and dangers include, but are not limited to, the hazards of being in a wilderness area, the forces of nature, and other risks and dangers because of the activities offered, and the nature of the grounds and facilities, at St. Crispin’s. I am aware that St. Crispin’s has 2 lakes and has a swimming pool on the premises, and that my child*/I may l have the opportunity to participate in aquatic activities, including, but not limited to, swimming, sailing, canoeing, and any other activity arranged for my child*/my or my child’s* group leader and/or St. Crispin’s directors. I am aware that St. Crispin’s offers team building high elements that are up to 35 feet high for which safety equipment (including helmets, harnesses and rope belays) will be used, and low elements that are up to three feet high for which ground spotters are used. I am also aware that St. Crispin’s offers other activities including, but not limited to, team and individual sports, miscellaneous games, hiking, mountain biking, Skeet shooting, archery and all aspects of camping. I understand that St. Crispin’s could be filming and taking photographs which might include my child*/myself and that St. Crispin’s might use such filming and photographs in promotional materials. I consent to my child*/myself being filmed and photographed and to use such filming and photographs for promotional purposes. I understand It is my sole responsibility to decide on and implement any activity restrictions which I deem necessary for my childs*/my personal welfare and safety.

AS ADDITIONAL CONSIDERATION FOR MY CHILD*/ME BEING PERMITTED TO PARTICIPATE IN ANY OF THE ACTIVITIES OFFERED BY ST. CRISPIN’S, I, INDIVIDUALLY AND ON BEHALF OF MY CHILD,* HEREBY AND RELEASE AND DISCHARGE ST. CRISPIN’S EPISCOPAL CONFERENCE CENTER, THE EPISCOPAL DIOCESE OF OKLAHOMA AND THEIR RESPECTIVE, DIRECTORS, OFFICERS, EMPLOYEES, AGENTS AND REPRESENTATIVES (ALL SUCH ENTITIES AND INDIVIDUALS BEING REFERRED TO COLLECTIVELY HEREINAFTER AS THE “RELEASED PARTIES”) FROM LIABILITY TO ME FOR LOSS OR DAMAGE, AND CLAIMS OR DEMANDS FOR LOSS OR DAMAGE ON ACCOUNT OF INJURY TO MY CHILD*/ME OR MY PROPERTY, WHETHER CAUSED IN WHOLE OR IN PART BY THE NEGLIGENCE OF THE RELEASED PARTIES, AND I FURTHER HEREBY AGREE TO DEFEND, INDEMNIFY, AND HOLD HARMLESS THE RELEASED PARTIES FROM ANY CLAIMS, LOSS, LIABILITY, DAMAGE, OR COSTS THAT MAY INCUR ARISING OUT OF OR IN ANY WAY RELATED TO MY CHILD’S*/MY PRESENCE ON THE PREMISES OF ST. CRISPIN’S AND/OR MY CHILD’S/MY PARTICIPATION IN ANY OF THE ACTIVITIES OFFERED BY ST. CRISPIN’S.

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I have read and voluntarily signed this release and indemnity, and I further agree that no oral representations, statements, or inducements apart from the foregoing written agreement have been made. I understand this document includes a release of all claims. In case of accidents or illness, I authorize St. Crispin’s to request and obtain necessary medical services for my child*/me should an emergency arise as determined by the director(s). I acknowledge and understand that the cost of any such medical care is my financial responsibility and/or that of my legal guardian, if any.

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In case of accidents or illness, I authorize St. Crispin’s to request and obtain necessary medical services for my child*/me should an emergency arise as determined by the director(s). I acknowledge and understand that the cost of any such medical care is my financial responsibility and/or that of my legal guardian, if any.

Date*

Signature of Participant*

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Date*

Signature of Legal Guardian(s) (if applicable)*

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Address*

Address Line 1

City

State

ZIP Code

Email*

Personal Phone*

Work Phone

Name and Phone Number of a person who should be contacted in the event the participant’s legal guardian cannot be reached/or participant needs medical attention:

First Name

Last Name

Phone Number*

Emergency Contact*

Phone Number*