No Insurance Release Form printable pdf download

No Insurance Release Form

(

for campers without medical insurance)

In consideration for Holston Presbytery Camp (“HPC”) permitting __________________________

(“Camper”), a minor, residing at {Address)______________________________________________

to participate in the HPC Summer Camp (“Camp”), including all of the physical activities involved

therewith AND in consideration for HPC agreeing to waive its requirement that all Camp participants be

insured under private insurance plans, Camper, by and through Camper’s parent(s)/guardian(s), herby

remises, releases and forever discharges HPC, as well as its affiliates, successors, assigns,

representatives, and employees from any and all actions, causes of action, claims demands, and

liabilities for, upon, or by reason of any damage, loss or injury to any person or to any property relating

to Camper’s participation in Camp and all activities pertaining thereto.

Camper, by and through Camper’s parent(s)/guardian(s), further agrees to indemnify and hold forever

harmless HPC against loss from any further claims, demands or actions arising from Camper’s

aforestated Camp participation that may hereafter be made or brought against HPC by any person or

entity.

Dated this _____ day of ______________________, 20____

____________________________________________

Signature of Camper

____________________________________________

Printed Camper’s Name

____________________________________________

Signature of Camper’s Parent(s)/Guardian(s)

____________________________________________

Printed Name of Camper’s Parent(s)/Guardian(s)

No Insurance Release Form