Toqque Partiicipant Waiver

W – 2019
PART
TICIPANT NAME (please print)

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PARE
ENT/GUARDIA
AN EMAIL AD
DDRESS

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DIETA
ARY RESTRIC
CTIONS (check
k any that apply)

 LLactose intoleerant  Vegetaarian (will eatt animal prodducts, but nott meat)
 GGluten-free  Vegan (no animal products
p whattsoever)

 OOther (pleasee specify) 

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ALLE
ERGIES

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Doess this allergy cause
c axis?  Yes
anaphyla s  No

RCH NAME & CITY

CHUR

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ATTE
ENDING: GEN
NDER:

 TToque Senior Higgh Retreat - Febbruary 1-3, 20199  MMALE

 TToque Junior Higgh Retreat - Marrch 1-3, 2019  FFEMALE
WAIV
VER
1) Dissmissal & Refun nds an acccident or injury occurring and tthat the Camp w will in no way be
a. C
Camp IAWAH, kn nown corporately as IAWAH Christian Ministriess respoonsible for any acccident or injuryy.
(“Cammp”), reserves th he right to dism
miss a guest who o in the Camp’ss b. In the event off accident or sicckness, the Cam mp including the
opinioon is a hazard to the safety and rights
r of others, or who appearss Camp p Directors and ttheir staff, are heereby released ffrom any liability y.
to havve rejected the reasonable contrrols of the Camp p; 4) **** Medical ***
b. N
No refund will be e made for dismmissals due to dissciplinary action, a. IIn the event thatt a medical need d arises, it is the
e responsibility of
o
late arrrivals or early departures. the naamed participan nt’s chaperone to o procure appro opriate treatmen nt
2) De claration of Cu ustody for thhe named partiicipant. Camp IAWAH is nott responsible fo or
a. Iff registering a minor,
m the parentt(s) or guardian((s) consenting to o mediccal treatment o r medical care of the named p participant when
this w waiver are tho ose having leg gal custody ov ver the named d they aattend with theirr youth group.
participant. 5) Peermission to Use e Likeness (Pho oto Waiver)
3) Asssumption of Rissk & Waiving of Camp IAWAH H’s Liability I give
e permission for tthe likeness of tthe named particcipant to be used
a. Given that ev very precaution is taken for the safety off in autthorized promottional materials of the Camp. Participants will
participants by the Camp,C I understtand and ackno owledge that by y not be e identified.
allowing the named d participant to participate in activities orr
progra ams at the Camp p I am assumingg full responsibiliity for the risk off

PARE
ENT/GUARDIA
AN NAME

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PARE
ENT / GUARD
DIAN SIGNATURE DATE

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om P. 613-273--5621 F. 613-273
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wah.com