Medical Treatment and Liability Release Form
California Civil Code Section 25.8
Its my desire that my child/ward participate in the activities of Junior Camp therefore: I, the undersigned parent/guardian of my camper, do hereby authorize the adult sponsor of Junior Camp, or any other responsible adult bearing this written authorization, into those said care the above ‘mentioned minor child has been entrusted, to obtain proper medical care from a licensed medical, dental, or care facility. The medical/dental care is to include, but not limited to, any x-ray examination, anesthetic, medical or surgical diagnosis, or treatment, and hospital care to be rendered to said minor under the general or special supervision and upon the advice of a licensed medical doctor or dentist.
It is understood that this authorization is given in advice of any specific diagnosis, treatment, or hospital care being required, but it given to provide authority and power on the part of said adult person to give specific consent of any and all diagnosis, treatment or hospital care which the aforementioned shall include transportation to receive the medical or dental care.
Financial Liability
In the event of injury to myself, or my child/ward I agree that I/we and my health care insurance provider shall be financially responsible for any medical treatment required or transportation required by myself, or child/ward as a result of any injury or illness suffered during his/her participation in any Junior Camp related activity.
Risk
I am aware that these activities may involve some hazards. I have considered these risks and I still wish myself, or my child/ward to participate. Furthermore, I agree not to bring legal action against the Western District or the Junior Camp Staff or said churches involved with Junior Camp as a result of any injuries suffered in the course of his/her participation.
Dispute
In the event a dispute arises between me and the Western District of the UPC or Camp staff concerning injuries to myself or child/ward, then I agree that the dispute shall be resolved by a Christian arbitrator acceptable to both sides. The cost of the arbitrator is to be shared equally by all parties. All applicable statutes of limitations shall apply and arbitration must be requested with the appropriate period in order to reserve a right to recovery.
Term of Agreement
This authorization will remain in effect while myself; or the minor above is in route to or from or involved or participating in any program or activity authorized by the Junior Youth Camp, unless revoked by the undersigned in writing and delivered to the agent of Junior Camp.
