Adult LPC Staff Informed Consent and Waiver Form
By signing this form, you are indicating that you have read and understand its contents and that you accept important legal obligations and waive legal rights.
Please clarify any concerns with the Camp Director before signing. This form must be signed and submitted to Lone Prairie Camp prior to your participation.
TO: Lone Prairie Camp, RR 1, Ferintosh, AB, T0B 1M0 ("LPC") RE: Annual Summer Camp ( - ) (The "Camp")
CAMP DESCRIPTION: https://loneprairiecamp.com/download/staff-welcome-letter/
I fully understand that there are inherent risks to participation in the activities listed below due to LPC’s rural location including, but not limited to, insect bites/ stings, scrapes, sprains & strains, bruises, broken bones etc.
Activities may include but are not limited to, participation in:
I understand that some activities may not be available and that I am not entitled to compensation in this situation.
Reasonable precautions are taken to ensure your health and safety including seeking to meet or exceed government and Alberta Camping Association Standards (http://www.albertacamping.com). These include:
I, the undersigned, give permission to the staff (paid and/or volunteer) of LPC to administer an Epipen in case of an emergency where I am unable to administer the Epipen independently.
I understand that illness and injuries sometimes occur through the participation in Activities. In the event that an emergency or other medical treatment is necessary, I consent to and authorize to be transported to the NEAREST SUITABLE MEDICAL HOSPITAL FACILITY. I hereby consent to and authorize emergency or other medical treatment as may be deemed advisable in the event of accident, injury, or illness during the Camp.
I understand that I am solely responsible to select and purchase adequate medical/health insurance for myself. Further, I understand that LPC carries liability insurance but that LPC is not required to carry no-fault medical/health benefits for me.
I also understand that although Lone Prairie Camp seeks to abide by all government regulations related to infectious disease risk mitigation, there is a risk of contracting an illness while at Lone Prairie Camp. I will inform my supervisor immediately if I become aware of any government guidelines of which Lone Prairie Camp management may be unaware.
I understand that my property may be damaged, lost or stolen during participation in the Camp and that I am not entitled to compensation in this situation.
I, the undersigned, understand and agree to obey and comply with safety regulations and instructions as directed by the person(s) in charge of LPC and the Activities. I will not deliberately endanger the safety of myself or others and understand that I can and will be sent home if, in the opinion of the person(s) in charge of LPC and the Activities, I am acting in a manner that could cause a hazard to the safety and well-being of myself and/or others. I agree that if I am sent home under such circumstances, I will be responsible for all associated costs incurred, including the cost of special travel arrangements.
I, for myself, voluntarily accept and fully assume such risks, dangers and hazards and the possibility of personal injury, infection, death, partial or permanent disability, property damage or loss resulting from my participation in the Activities. I release, indemnify and hold harmless LPC and the Baptist General Conference in Alberta (BGCA), and each of their respective trustees, directors, officers, corporation members, employees, agents, volunteers, consultants, successors, insurers, members, representatives, assigns and subsidiaries from:
I acknowledge that I have read and understand the terms of this Informed Consent and Waiver Form and acknowledge that by signing this Form voluntarily, I am agreeing to abide by its terms and I am waiving certain legal rights that I may have. I agree that this consent and waiver is binding upon myself, my heirs, executors, administrators, successors and assigns.
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If you have questions about the contents of this document, you can email the document owner.
Document Name: Adult LPC Staff Informed Consent and Waiver Form
Agree & Sign