September 2-4, 2022 Scranton Road Bible Church Teen Whitewater Rafting

September 2-4, 2022 | Please fill out this form and click submit for each child you wish to register for the 2022 SRBC Whitewater Rafting Trip. Fee is $125 per student, scholarships are available.

*scholarships available.
Please contact Scranton Road Bible Church at 216-861-7539 for more information.
Participant Info (Please complete for each teen attending camp)

 
 
Emergency Contact Info

 
 
 
 
 
 
RELEASE OF LIABILITY FOR MINOR PARTICIPANTS

READ BEFORE SIGNING


IN CONSIDERATION OF my child/ward being allowed to participate in any way in the Scranton Road Bible Church Teen Whitewater Rafting Trip 2022 at Adventures on the Gorge in Lansing, WV and related events and activities, the undersigned acknowledges, appreciates, and agrees that:


The risks of injury and illness to my child from the activities involved in these programs are significant, including the potential for permanent disability and death, and while particular rules, equipment, and personal discipline may reduce these risks, the risks of serious injury and illness do exist;


The risk to have direct or indirect contact with individuals who have been exposed to and/or diagnosed with one or more communicable diseases, including but not limited to COVID-19 or other medical conditions, diseases, or maladies, and/or any mutation or variation thereof does exist and it is impossible to eliminate the risk that my child/ward could become infected through contact with or close proximity to an individual with a communicable disease; and,


1. FOR MYSELF, SPOUSE/COPARENT, AND CHILD, I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASES or others, and assume full responsibility for my child’s participation; and,


2. I willingly agree to comply with the program’s stated and customary terms and conditions for participation. If I observe any unusual significant concern in my child’s readiness for participation and/or in the program itself, I will remove my child from the participation and bring such attention of the nearest official immediately; and,


3. I myself, my spouse, my child, and on behalf of my/our heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS Scranton Road Bible Church; its directors, officers, officials, agents, employees, volunteers, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event (“Releasees”), WITH RESPECT TO ANY AND ALL INJURY, ILLNESS, DISABILITY, DEATH, or loss or damage to person or property incident to my child’s involvement or participation in these programs, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law.


4. I, for myself, my spouse, my child, and on behalf of my/our heirs, assigns, personal representatives and next of kin, HEREBY INDEMNIFY AND HOLD HARMLESS all the above Releasees from any and all liabilities incident to my involvement or participation in these programs, EVEN IF ARISING FROM THEIR NEGLIGENCE, to the fullest extent permitted by law.


5. I, the parent/guardian, assert that I have explained to my child/ward: the risks of the activity, his/her responsibilities for adhering to the rules and regulations, and that my child/ward understands this agreement.


I, FOR MYSELF, MY SPOUSE/COPARENT, AND CHILD/WARD, HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT WE HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

 
 

UNDERSTANDING OF RISK

 
 
SELECT PAYMENT

Fee is $125 per participant and includes transportation to and from Lansing, WV, lodging, meals and full-day whitewater rafting.
Select the appropriate payment option below.   
Individual: $125
 

Description

September 2-4, 2022
Please fill out this form and click submit for each child you wish to register for the 2022 SRBC Whitewater Rafting Trip. Fee is $125 per student, scholarships are available.

*scholarships available.
Please contact Scranton Road Bible Church at 216-861-7539 for more information.