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PERMISSION/HOLD HARMLESS/MEDICAL RELEASE AGREEMENT
Camp Tonkawa,
1036 CR 203,
Collinsville Texas 76233
Event name: ___________________________________________________
1. I hereby agree that my participation in the above Camp Tonkawa event date is entirely voluntary.
2. I further state that I am aware of all inherent dangers of participation and risks involved in various outdoor activities and I assume full responsibility for myself and any of my dependants for bodily injury, death, loss of personal property and expenses thereof as a result of those inherent risks and dangers and my/our negligence in participating in the activities. Including but not limited to Horseback riding, Archery, Swimming, Fishing and the like and are done at my own risk.
3. Animals, reptiles, insects & similar life in the wild are unpredictable and sometimes carry inherent risks which include allergic reactions. As for horses, According to the Civil Practice & Remedies Code of Texas Law, Chapter 87, An equine owner is not liable for an injury to or for the death of a participant in equine activities resulting from the inherent risk of equine activities. Also Camp Tonkawa owners, their agents, volunteers, employees, instructors, officers or agents are not responsible for any bites, stings, or injury resulting from camp activities. Campers and their chaperones or guests assume all the risks of participating.
4. I ACKNOWLEDGE, UNDERSTAND, DECLARE, AND AGREE that to the best of my knowledge, I am in good physical condition and have no disease or injury that would be aggravated by participating in Camp Tonkawa's activities.
5. I consent to all emergency medical treatment, given through a Camp Tonkawa representative or a medical professional, as may be deemed appropriate under existing circumstances associated with camp activities. I authorize Camp Tonkawa and its representatives to transport me by whatever means is available at the time, to a nearby medical facility if need be or place me in the care of a local physician for treatment. I further agree that all expenses incurred in rendering these services, including transportation, whether placing me in a hospital and/or in the care of a physician, will be a debt and liability I am responsible for and I agree to make repayment, time being of the essence. My insurance Company & phone#__________________________________.
6. Therefore, I agree on behalf of myself, dependents, my assigns, executors, and heirs, to release, indemnify, covenant not to sue, waive, discharge and hold harmless, Camp Tonkawa, its trustees, officers, agents, employees, owners and volunteers whatsoever arising out of or in any way related to my participation in camp events, including any act or omission of any third party.
7. I have read and understand the terms of this "Agreement and Release" and agree to all terms and conditions on behalf of myself, heirs, representatives, executors or administrators. I hereby certify that by my signature that I am physically fit and capable of participating.
8. I acknowledge that travel to and from Camp Tonkawa involves the use of private passenger vehicles not owned or controlled by Camp Tonkawa and that I am of lawful age and legally competent to sign this affirmation and release and that I have signed this document as my own free act.
9. I hearby agree that all photos taken of me by camp staff are the property of Camp Tonkawa, and may be used in Camp Tonakawa publications and website.
Participant/s and age/s __________________________________________________________________________
Signature of adult/guardian______________________________________and date___________________ (this form shall remain in file, be in effect & valid for all the "Homeschool Day Camp" classes attended & not needed to refill out for 1 year from date signed)
Emergency contact name_______________________________ Emergency contact phone number_____________________