Please read each section carefully and check the boxes to acknowledge.
RCCG Zone 5 Children's Day Camp / Field Trip Waiver
Agreement for Assumption of Risk, Indemnification, Release, and Consent for Emergency Treatment. I desire for my child to participate voluntarily in the RCCG NA IL Zone 5 Children's Day Camp Program. I understand that I am being asked to read each of the following paragraphs carefully on behalf of my child. I understand that if I wish to discuss any of the terms contained in this agreement, I may contact Pastor Iretiola Olu-Ajeigbe at phone number 815-701-4703.
Assumption of Risks
I understand that Day Camp, by its very nature, carries with it certain inherent risks that cannot be eliminated regardless of the care taken to avoid injuries and/or illness. I am aware of the risks of my child's participation, which include, but are not limited to, minor injuries such as bruises, contusions, broken bones, and concussion, as well as catastrophic injuries such as paralysis. I understand that I have been advised to seek the advice of my child's physician before allowing my child to participate in the above-listed activity. I acknowledge that I have been advised to have health and accident insurance in effect for my child and that no such coverage is provided by RCCG NA IL Zone 5. I know, understand, and appreciate the risks inherent in the above-listed activity. I hereby confirm that my child's participation is voluntary and that, on my child's behalf, I knowingly assume all such risks.
Hold Harmless, Indemnity and Release
In consideration of my child's participation in these activities, I, as the child's parent or legal guardian and on behalf of my child, our heirs, personal representatives, estate, or assigns, agree to defend, hold harmless, indemnify, and release the Releasees and their officers, employees, agents, and volunteers from and against any and all claims, demands, actions, or causes of action arising from damage to personal property or personal injury that may result from my child's participation in the above-listed activity. This release includes claims based on the negligence of the Releasees and their officers, employees, agents, and volunteers, but expressly does not include claims based on intentional misconduct or recklessness. I understand that by agreeing to this clause, I am releasing claims and giving up substantial rights on behalf of myself and my child, including the right to sue.
Consent for Emergency Treatment
I authorize Pastor Iretiola Olu-Ajeigbe and designated representatives of RCCG NA IL Zone 5 to consent, on my behalf, to any emergency medical or hospital care or treatment for my child upon the advice of a licensed physician. I agree to be responsible for all necessary charges incurred through any hospitalization or treatment provided under this authorization.
