Camp Rise Teen Weekend Release

I, the Parent/Guardian, on behalf of my minor child, as listed above, understand that use of the Southwestern Diabetic Foundation and/or Camp Sweeney facilities and participation in facility programs and events creates a risk of injury and therefore expressly consent to and assume all risks associated with use of the Southwestern Diabetic Foundation and/or Camp Sweeney facilities and participation in their programs and events, even those which are not specifically foreseeable, and release, indemnify, defend, and hold harmless Southwestern Diabetic Foundation, Camp Sweeney and their directors, officers, employees, and agents (the “Released Parties”), from any loss, liability, claim, action, or suit (“Claim”) arising or alleged to arise from (A) bodily injury or personal injury suffered by any party on the Southwestern Diabetic Foundation and/or Camp Sweeney facilities, (B) bodily injury or personal injury caused by a participant in facility programs and events (including off-site trips) and/or (C) property damage or loss suffered in connection with, or as a result of, my or my minor child’s use of Southwestern Diabetic Foundation and/or Camp Sweeney facilities or participation in their programs and events (including off-site trips), regardless of whether such claims and actions are founded in whole or in part upon alleged negligence of the Indemnified Parties. I specifically and explicitly release, indemnify and hold harmless the Released Parties (defined above) from all liability, claims, demands, actions or rights of action, or damages of any kind including but not limited to those arising out of or relating to any one or more of the Released Parties’ own sole, contributory and/or comparative negligence. I knowingly and voluntarily release, indemnify and hold harmless the Released Parties from any such claims. I have read and understand the above waiver. This Indemnity and Release is made and is performable in Cooke County, Texas. I agree that exclusive venue for all claims arising from or related to this agreement, including claims for personal injury, lies in Cooke County, Texas.

PARTICIPATION: I, the Parent/Guardian, give permission for my child to participate in all of the Camp Sweeney program activities on or off the Camp Sweeney property.

VIDEO/PHOTOS: Many pictures will be taken of all the children who attend Camp Sweeney. In addition, some video, live and recorded internet broadcasts and interviews will be taken during this session. I give the Southwestern Diabetic Foundation, Inc. permission to use the pictures, interviews, live and recorded internet broadcasts, internet pictures and videotapes of our child in any of its publicity campaigns and/or websites.

TREATMENT: I authorize the medical staff at Camp Sweeney or Southwestern Diabetic Foundation to administer or authorize routine and emergency medical treatment in my absence. I understand that every reasonable effort to notify me will be made prior to rendering emergency treatment. I understand that if any medical expenses occur during the course of camp including x-rays, blood tests, medications, and/or emergency room visits, the camper’s guardians will assume financial responsibility for expenses not covered by the camper’s insurance. In addition, both the camper and the camper’s guardian agree for the release of any medical information acquired by Southwestern Diabetic Foundation and/or Camp Sweeney to be released to the camper’s referring physician.

BEHAVIORAL RULES/PROCEDURES: The camper and the camper’s guardian agree that the camper will abide by the behavioral rules and procedures set forth by Camp Sweeney for the safety of all campers and staff.

I, the Parent/Guardian, certify that the information provided in this application is true and correct and authorize investigation of these facts by any authorized representative of Camp Sweeney. I have read and agree to all the above releases and authorizations with regards to the camper’s stay at Camp Sweeney.