Please fill out the following form in order for EACH PARTICIPANT AND CAMPER to participate in camp.

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CONSENT TO PARTICIPATE & RELEASE OF LIABILITY

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CONSENT TO PARTICIPATION & ASSUMPTION OF RISK:

As the parent or guardian of the Camper, I acknowledge that there are risks inherent in any week-long program involving physical activities conducted in a rural camp setting, including, but not limited to, bodily injury or death.

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By signing below, I voluntarily consent to the Camper’s participation in the program and activities provided by Camp Braveheart on the premises of Ridge Haven, Inc. in Brevard, NC, and assume all risks of possible injury that may arise.

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RELEASE & WAIVER OF CLAIMS:

In consideration of the Camper being permitted to attend and participate in the activities of Camp Braveheart and the benefits to be derived therefrom, I, for myself, the Camper, my heirs, and personal representatives or assigns, do hereby waive, release and discharge forever any and all claims against any of the Released Parties (defined below) for damages, losses or liabilities involving bodily injury, death, damage to reputation, or damage or loss of property that I or the Camper may experience as a result of any act or omission, even if arising from the negligence of the Releases, occurs in connection with the Camp Braveheart program that is related to or arises from the Camper’s participation in the program activities or the facilities or property owned or managed by Ridge Haven, Inc. (“Claims”). This waiver and release applies to any Claims against the following “Released Parties”: Braveheart Grief Ministries, Inc., Camp Braveheart, Ridge Haven, Inc. (which is the location where the program is conducted), the Camp’s Director, Martha M. Furman, LPC, LMFT, all other professional counselors, camp counselors, staff members and volunteers of Camp Braveheart or Ridge Haven, Inc., as well as other Campers who are attending Camp Braveheart with the Camper.

 

ELECTRONIC DEVICE POLICY:

Camp Braveheart provides an electronics-free environment so that campers enjoy the outdoors and social interactions.  Camp counselors and staff will have cell phones for camp communication and emergencies. Campers will have access to a phone if they need to call home. We realize many campers need electronics for their safe travels to and from camp. Once at Camp, electronics must be packed away or stored while attending camp. Braveheart Grief Ministries, Inc. is not responsible for any electronics lost, broken, or left behind.

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By my signature below, I represent to Camp Braveheart and its Director (Ms. Furman) that I am the parent or legal guardian of the Camper registered for this camp and I have read and understand the terms of the release and waiver of Claims and assignment of rights. voluntarily agree to the above provisions and certify that I have also executed the

required Medical Consent Form required for participation in Camp Braveheart.

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PHOTOGRAPH AND VIDEO CONSENT and MEDICAL CONSENT FORM

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PHOTOGRAPH AND VIDEO CONSENT:

I understand that photographs and videos are taken of participants during Camp Braveheart activities. I grant permission for these photographs and videos to be used on the Camp Braveheart’s webpage and for purposes for publicity, illustrations and advertising.

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MEDICAL CARE CONSENT AND AUTHORIZATION:

Before medical treatment can be provided to a minor, the law requires appropriate consent from a parent or guardian.  As the parent or guardian for the Camper, my signature below hereby authorizes Camp Braveheart, the Camp’s Director (Martha M. Furman, LPC, LMFT) or one of her designees to obtain medical treatment for the Camper so that care can be obtained promptly and without unnecessary delay.

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My signature below hereby authorizes the Camp’s Director, as well as staff and volunteer members of Camp Braveheart and/or Ridge Haven, Inc., to act for me according to their best judgment in the event routine medical care may be needed and/or a medical emergency arises. I hereby grant permission for all procedures or services deemed

medically advisable to treat or relieve, or to attempt to treat or relieve, any illness, injury, and/or condition to be provided by trained and authorized Camp staff, a nurse, a rescue squad, a private physician, nurse practitioner or physician’s assistant, and/or a hospital or emergency urgent care facility and their employees, under the same circumstances as needed. Any such action will be taken in the best interest of the Camper and will be reported to me as soon as possible.

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In this regard, my signature waives and/or releases Camp Braveheart of all liability and/or financial responsibility for any medical expenses incurred. I acknowledge and agree that I am solely responsible for all expenses, costs and fees associated with providing medical care or treatment to the Camper. I agree that any health history provided by me or

the Camper is correct to the best of my knowledge.

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Contact Information of OVER 18 SIGNER or Parent/Guardian

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