If the school that you go to is not listed please select the Young Life Club that you attend.

Accident Coverage I understand that my personal insurance will be primary coverage for accidents and that Young Life’s insurance is secondary up to a maximum of $20,000 ($4,000 for dental claims). Exception: if the total claim is less than $250, Young Life will pay the full amount. On claims above $250, Young Life will coordinate payments for deductibles and co-pays. Young Life’s policy does not cover camper illnesses or pre-existing conditions. If you have questions, please contact Young Life Risk Management at (719) 867-3600. For all camps and travel outside of the USA, you are responsible to confirm that your medical insurance provides coverage for accidents or illness outside of the USA and/or you have purchased international travel medical insurance for yourself or your child. You also acknowledge and agree that you are personally responsible for any and all medical costs including all emergency medical transportation that are not covered by your personal medical health insurance.

AUTHORIZATION FOR TREATMENT I/We hereby give permission to the medical personnel selected by Young Life to secure and administer treatment and to maintain and/or release any medical records necessary for insurance purposes to provide or arrange necessary related transportation for the above named person. I have received notice and agree to the release of my personal information and required health information as outlined in Young Life’s “Privacy Statement.” Available at https://www.younglife.org/privacy-policy/.

INDEMNITY AND CONTRACT AGREEMENT I have been informed of the risks related to this Event, including any inherent risks that cannot be eliminated, and I expressly assume any and all risks of injury, illness or infectious and/or contagious diseases or sicknesses, death, or damage to my person or property arising from or relating to my or my child’s participation in the Event, including travel to and from the Event. In doing so, I acknowledge and certify that I, or my child, am/is fit to participate in this Event and have not been advised otherwise by a qualified medical person. I recognize that my/my child’s participation in the Event is a privilege and as consideration for this privilege, I waive and release any and all actions, claims, suits or demands of any kind or nature whatsoever against Young Life, its corporate affiliates, contractors, vendors, officers, agents, sponsors, volunteers or representatives of any kind (collectively “Releasees”) arising from or relating in any way to my/my child’s voluntary participation in the Event, including travel to and from the Event and the Activities at the Event, unless arising out of the willful or grossly negligent act of the Releasees, and I agree to indemnify the Releasees should any such loss, damage or claim occur. Young Life is committed to the safety of all participants. I understand that weapons of any kind are not permitted at any Young Life activities, camps or events. I verify that I/my child named is in good health and capable of participating in strenuous activities and, when necessary, will tailor my/their activities to those within the bounds of my/their physical health. I further acknowledge that I have had an opportunity to inquire about the kinds of activities which will take place at the Event and that I/my child am capable of participating in all activities except what I indicated in the limitations to activities section above. I understand that participation in Young Life activities requires the use of certain safety equipment. I have been provided information on the safety equipment that I, or my child, will be required to wear at all times during the specific activity. I understand that I, or my child, assumes responsibility for inspecting the safety equipment prior to its use to ensure that the safety equipment is in good condition and to timely notify Young Life if there are any concerns prior to using the safety equipment. I understand that signing this Consent/Release means, among other things, that if I am/my child is injured or dies as a result of my/their participation in the Event, I, and/or my family or heirs cannot under any circumstances sue Releasees for damages relating to or caused by my injuries or death. I recognize and acknowledge that Young Life is neither a common carrier or in the business of providing transportation services. In consideration for allowing myself and/or my child to be transported to and from the Event with Young Life, I further reaffirm my assumption of the risks of being transported to and from the Event on behalf of myself and/or my child. I also understand that if circumstances arise where I deem it necessary for I and/or my child to be transported from the Event through a transportation method outside of Young Life, I do so at my own risk and agree to release the Releasees from any and all liability related to such decision. I have read this Waiver, Release and Indemnification Agreement, have asked and received answers to any questions I had concerning its meaning and execute it freely, without duress, and in full complete understanding of its legal effect.

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