WAIVER

 

By signing this waiver, you agree that you may be giving up legal rights and remedies available to you and your family. Read and complete this waiver carefully. If you have any questions, contact an attorney.

 

Participant Name:                                                                          

Parent/Guardian's Name (if Participant under the age of eighteen):

                                                                                                                             

Participant Home Address:                                                                                                

                                                                                                                             

                                                                                                                             

 

Parent/Guardian Emergency Contact Name and Telephone Numbers:

Name:                                                                                Relationship:                           

Home Phone:                                             Work Phone:                                                  

Cell Phone:                                                           

If Parent/Guardian Unavailable, Alternate Emergency Contact Name and

Telephone Numbers:

Name:                                                                                Relationship:                           

Home Phone:                                             Work Phone:                                                  

Cell Phone:                                                           

 

Please Initial each Paragraph after you have read it to show you have read and agree.

 

1.                     .  I understand that the 12th Annual Alaska Ablaze Native Family/Youth Camp (the "Camp"), sponsored by Mentasta Traditional Council, Ahtna, Inc., Delta Christian Center, Mentasta Christian Center, Faith Harbor Fellowship, Door of Hope Church, Alaska Hunting Adventures, and their member organizations is located in Mentasta Lake Village, Alaska located in a remote area approximately fifty-four miles from a medical facility.

2.                     .  I understand that the Camp will run from June 23, 2008 to June 28, 2008, and that approximately one hundred youth and adults will attend the Camp.

3.                     .  I acknowledge that I have voluntarily applied to participate in all the activities of the Camp, including but not limited to, Camping, Swimming, Boating, Fishing, Mountain climbing, hiking, ATV's or snowmobiling, Pistol or rifle target shooting, Bow and Arrow target shooting, Basketball, Baseball, Youth activities- physical games, etc., Dancing, Eating and Drinking, and Mountaineering.

4.                     .  I understand that the activities listed above, and all other hazards and exposures connected with related outdoor activities and the set up and take down of camp facilities, involve risk of harm. I am aware of the risks and dangers inherent with those activities, and I knowingly and willingly assume the risk of injury to myself, including injury that might result, whether obvious or not obvious.

5.                     .  I agree that any bodily injury, death, or loss of personal property and expenses as a result of my negligence while attending and participating in the Camp is my responsibility.

6.                     .  I understand that accidents or illness can occur in remote places without medical facilities, physicians, or surgeons, and may be aggravated by exposure to temperature extremes or inclement weather.

7.                     .  In consideration of and as a part payment for the right to participate in activities organized by Mentasta Traditional Council, Ahtna, Inc., Delta Christian Center, Mentasta Christian Center, Faith Harbor Fellowship, Door of Hope Church, Alaska Hunting Adventures, and their member organizations and any other related activities, I agree and state that I am fully capable of participating in these activities, I am in excellent health with no known physical handicaps that might hinder my full participation in those activities, and I am fully capable of handling the hazards of traffic, weather conditions, walking, and all and any similar conditions associated with the activities scheduled by the above organizations during the Camp and related activities.

8.                     .  For value received, I agree on behalf of myself, my child's other parent if known or living, my child named herein, and our heirs, successors, and assigns ("Our Behalf") that I assume all risks and waive any liability of any nature whatsoever against and agree to indemnify and hold harmless Mentasta Traditional Council, Ahtna, Inc., Delta Christian Center, Mentasta Christian Center, Faith Harbor Fellowship, Door of Hope Church, Alaska Hunting Adventures, et al. and Members et al. with respect to and from any and every claim, demand, action or right of action, of whatever kind or nature, either in law or in equity arising from or by reason of any bodily injury or personal injuries known or unknown, death or property damage resulting or to result from any accident that may occur as a result of my participation in the Camp and its activities whether by negligence or not that may be made or brought on our Behalf against Mentasta Traditional Council, Ahtna, Inc., Delta Christian Center, Mentasta Christian Center, Faith Harbor Fellowship, Door of Hope Church, Alaska Hunting Adventures, et al. and/or Members et al. arising out of or in connection with my own or my child's travel to or attendance at the Camp, or any other activity my child may engage in while in the Mentasta Lake Village area.

9.                     .  Further, for value received, for any injury to third parties that may arise because of my own or my child's actions or omissions, I agree to hold harmless and defend Mentasta Traditional Council, Ahtna, Inc., Delta Christian Center, Mentasta Christian Center, Faith Harbor Fellowship, Door of Hope Church et al. and Members et al. with respect to any and all actions, claims, expenses, or demands arising there from that may be made or brought against Mentasta Traditional Council, Ahtna, Inc., Delta Christian Center, Mentasta Christian Center, Faith Harbor Fellowship, Door of Hope Church Alaska Hunting Adventures, et al. and/or Members et al., including but not limited to reasonable attorney's fees and expenses arising in connection therewith.

10.                    .  I further release all officials and professional personnel from any claim whatsoever on account of first aid, treatment or service rendered me during my participation and attendance at the Camp.

11.                    .  I have carefully read this agreement and fully understand its contents. I am aware that I am releasing legal rights that I otherwise may have and I enter into this contract in behalf of myself and my family of my own free will, and with full comprehension and awareness of the risks involved.

 

THIS IS A RELEASE OF LIABILITY. DO NOT SIGN OR INITIAL THE RELEASE IF YOU HAVE NOT READ IT COMPLETELY OR DO NOT UNDERSTAND OR DO NOT AGREE WITH ANY OF ITS TERMS.

 

 

 

                                                                                              

Printed Name of Participant                             Date

 

                                                                                              

Printed Name of ParticipantŐs Parent/Guardian    Date

 

                                                                                              

Signature of Participant or Parent/Guardian                 Date