Although precautions are taken to provide proper organization, instruction, and equipment for your child’s participation in our programs, there can be no guarantee of absolute safety against injury and unforeseeable accident. There are elements of risk in any adventure, sport, or program involving physical exertion and risk taking, or associated with the outdoors (referred to herein as “activity”), and the use of any equipment or animals for the activity. I, on behalf of myself, my child, and any other parent of the child, understand that my child may be involved in activities including but not limited to sailing, water-skiing, horse riding, canoeing, swimming, team building initiatives, boating, ropes course, climbing, rappelling, and/or other physical activities. Some of these activities are rugged adventure recreational activities. I acknowledge that my child may decline to participate in any activity. Any participation will be voluntary.
ACKNOWLEDGMENT OF RISKS: I recognize that there is inherent danger in any activity which involves physical exertion or risk taking; that natural hazards do exist; that although the program may not be strenuous, injuries or medical complications may occur; that certain foreseeable and unforeseeable events unique to each individual activity can contribute to the unpredictability of the activity; that balance and physical coordination may affect the occurrence of accidents or falls; and that I should ask about other potential hazards and recommended precautions and procedures.
EXPRESS ASSUMPTION OF RISK AND RESPONSIBILITY: In recognition of the inherent risks of the activity which my child will be engaged in, I confirm that my child is physically and mentally capable of participation in the activity and/or using equipment. I understand that my child will be participating willingly and voluntarily and I assume full responsibility for personal injuries, accidents or illnesses, including death. I also assume responsibility for damage to or loss of personal property as the result of any accident that may occur.
On behalf of myself, my child, and any other parent of the child, I assume the risk(s) of personal injuries, accidents, and/or illnesses, including, but not limited to, sprains, torn muscles and/or ligaments; fractured or broken bones; eye damage; cuts, wounds, scrapes, abrasions, and/or contusions; dehydration, oxygen shortage (anoxia), exposure and/or altitude sickness; head, neck, and/or spinal injuries; animal or insect bite or attack; injury caused by discharge of any weapon; shock, paralysis, and/or death.
TERMINATION OF ACTIVITY: I recognize that you, as provider of services, may find it necessary to terminate any activity due to forces of nature, medical necessities, or other problems; and/or to terminate the participation of any person you judge to be incapable of meeting the rigors or requirements of participating in the activity. I accept your right to take such actions for the safety of my child and/or other participants. I acknowledge that no guarantees have been made with respect to achieving objectives.
AUTHORIZATION: I hereby authorize any medical treatment deemed necessary in the event of any injury to my child while participating in the activity. I will have appropriate insurance or, in its absence, I agree to pay all costs of rescue and/or medical services as may be incurred on behalf of my child.
RELEASE: In consideration of services or property provided, I, for myself, for my child, and for any other parent of the child, do hereby release the Muncie Family YMCA, the Muncie YMCA of Indiana Inc., Camp Crosley YMCA, its principals, trustees, directors, officers, agents, employees and volunteers, and each and every land owner, municipal and/or governmental agency upon whose property an activity is conducted, from all liability with respect to my child and I waive any claim for damage arising from any cause whatsoever, except for any claims which are the result of gross negligence of the party or parties released herein. I authorize the YMCA to take and use any photographs, slides and videos of my camper for promotional purposes, brochures, flyers, website and the internet.
Parent/Legal Guardian Signature (Camp Crosley YMCA Summer Camp Release of Liability)
Type Parent/Legal Guardian's Name of Signature Above
Date of Signature