Sample Permission To Treat (Page 2 of 2) in pdf

Sample Release Form

I have requested

(The camp)

to allow me to participate in

(Activity)

. As a

condition of receiving this benefit, I, the undersigned, do hereby agree to the following:

I understand that my participation in this activity can expose me to dangers both from known and

unanticipated risks. Acknowledging that such risks exist, I hereby release and discharge

(The

camp), its officers, agents, and employees from any and all claims or liability for personal injury or

property damage I may suffer while participating in the activity; including, but not limited to, any claim

arising out of any condition of the premises at which the activity is held or the conduct of any person in

connection with the preparation for, supervision of, or conduct of any activity, whether planned or

unplanned. I specifically agree to release and hereby release

(The camp)

and the

officers, agents, and employees of the camp for any negligence of the camp, or its officers, agents or

employees.

_________________________________

Signature

____________________________________________________________________________________

Name and Address Printed

Sample Hold Harmless Agreements

Lessee agrees to indemnify, hold harmless and defend lessor, and all of the lessor’s officers, agents and

employees, from and against all liability for injuries to or deaths of persons or damage to property caused

by lessee’s use of, occupancy of, or operations upon the demised premises, provided, however, that this

covenant shall not extend to liabilities incurred from any negligent acts or omissions of the part of the

lessor and its officers, agents, or employees.

(Group)

agrees to indemnify and hold harmless

(The lessor)

, its officers,

agents and employees from and against every expense, including attorney’s fees, liability or payment by

reason of any damages or injury to persons (including death) or property (including loss of use or theft

thereof) arising out of or in connection with the conference, including use or occupancy of

property, facilities, or equipment, provided that such damages or injury are caused in whole or part

(The lessor)

, its officers, agents, employees, or participants.

Information on a wilderness canoe trip might include:

Campers will be in groups of twelve with three staff members, each of whom is trained in water rescue

and first aid. One trip leader is certified in wilderness first aid. At most points on the trip, the group will be

a minimum of two hours from professional medical care. Trip leaders will carry cellular phones that are in

cellular service areas for all but one day on the trip. On that day, phones for use in an emergency are not

available. The group will be up to six hours from the nearest cellular area. Campers may be subject to

extremes in weather, and will be held responsible for their own behavior on the trip. Understanding these

situations, I hereby give permission for my child ________ to participate in this trip sponsored and

supervised by Camp White Cloud in the summer of ____.

Sample Permission To Treat Page 2

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