Activity Release Form

Your safety is important to us. Please read this document carefully. It affects the legal rights of you and any child of yours who might be a visitor to Camp Allen. This document must be signed by all adults (eighteen years and older) and the parents of all minor visitors before participating in any activities at Camp Allen which include horseback riding, nature walks, aquatic activities, skeet shooting and challenge course elements among others.

Group / Event Name*

Activity Date(s)*

Adult/ Legal Guardian Name*

First NameLast Name

Adult/ Legal Guardian Birthdate*

Date

Health Insurance Company

Health Insurance Policy #

Health Insurance Policy Holder

Email*

Mobile Phone*

Emergency Contact Name*

Emergency Contact Phone*

Please enter the names of minors or spouse to be included on this release.

HORSEBACK RIDING. initial Minimum age is 10 yrs. old; Minimum age for arena rides: 6 yrs.; Max. Weight: 180 lbs.; One person per horse. Under Texas Law (Chapter 87, Civil Practice and Remedies Coe), an equine professional is not liable for injuries equine activitiesresulting from the inherent risks of equine activities.NATURE WALK. Wear appropriate clothing and sturdy, closed toed shoes that won’t slip or slide off. Long sleeves, a hat, sunglasses, and sunscreen arerecommended.AQUATIC ACTIVITIES. Wear appropriate clothing. In order to participate, you must wear a life jacket at all times. Any personal items that you do not want to get wet should be left on dry land. If at any time your behavior is unsafe you may be asked not to participate.SKEET SHOOTING & ARCHERY. Camp Allen will provide all equipment. No other weapons are allowed on the premises. You should stay behind the protective barriers while shooters are in their position. Age minimum for skeet shooting is 12 years old if accompanied by parent or guardian.CHALLENGE COURSE. Though there is an inherent risk to all challenge course activities, the following can help you reduce the risk of injury to yourself and others: Always know you have the choice to not participant at any time. Wear appropriate clothing: sturdy, closed-toed shoes that won’t slip or slide off.HIKE & BIKE TRAILS. An adult (18+) must sign release and accompany riders 10 yrs. & older. Bikes must be ridden on Hike and Bike Trail only. Wear appropriate clothing and sturdy, closed toed shoes that won’t slip or slide off. Helmets should be worn at all times. Bikes are not allowed on trail during or after rain. Damages beyond normal wear and tear will be charged to customer. Give Pedestrians right of way at all times. I.D. is required for bike check out.HAYRIDES. Children ages 8 & under must be accompanied by an adult. Riders must be seated at all times.NONE

I understand that the event or activity may itself present certain hazards and risks which may involve the user of Camp facilities and equipment and the services of the Camp staff, all of which may include the possibility of harm or loss to me, or the child. I am the parent or guardian of a child who is visiting the Camp. I have discussed these activities and risks with the child, who understands them. I acknowledge that I have fully satisfied myself as to the nature of the activity or activities that I will be participating in, the risks associated with each activity, and my responsibility to know my limits and comply with the safety standards.I affirm that my health or that of the child is good and that I know of no reason why participation in the activities might cause harm to the child, others, or me. I have chosen to participate in an activity and accept full responsibility for my choices. I agree for myself and, if I am a parent or guardian of a visiting child, on behalf of that child, to release and agree not to sue the Camp Allen Camp and Conference Center, The Episcopal Diocese of Texas, and the affiliate, Governing Boards, staff and contractors of each (released parties) from any claim which I may have for injury, death or other loss incurred in any way related to my visit to the Camp. Parents sign this agreement for him or her and, to the maximum extent allowed by law, on behalf of each minor child who is a visitor. The acknowledgement and assumption of risks and the agreements of release and indemnity include losses and claims arising in whole or part from the negligence, but not the gross negligence or intentionally wrong conduct, of a released party.In the event emergency aid/treatment is required due to illness during the process of receiving services, or while being on the property of CampAllen, I authorize Camp Allen personnel to:1. Secure and retain medical treatment and transportation, if needed.2. Release guest records upon request to the authorized individual involved in the medical emergency.This release is binding upon my heirs, executors, and assigns.

Signature*

Today's Date*

Date