This permission slip covers the following summer camps. 
Please indicate below the camp(s) your student will be participating in. *
Is participant covered by personal/family medical insurance? *

Please complete this form, sign, and date and once you click submit the form will automatically email to the school office.

Participation Agreement

Medical Release:  I recognize that as a result of participation in the Activity described above that emergency medical treatment may be necessary for the Participant and that Horizon personnel may be unable to contact me prior for my consent to emergency care.  I therefore give consent in advance for such emergency care, including first aid treatment, transportation to a medical facility, and medical/hospital care as deemed necessary. I authorize and consent to all medical, surgical, diagnostic, and hospital procedures as may be performed or prescribed by a physician. I waive my right to information prior to such treatment. I authorize and request personnel from Horizon Community Church/Christian School/Learning Center to administer or supervise such treatment and to do any procedure that they deem necessary until such time as the Participant can be safely transported to a doctor or hospital.

Transportation Release: I give my permission for my Participant to travel to activity, sport or event in vehicles driven by Horizon approved adult drivers.

Media ReleaseI also irrevocably and for perpetuity authorize and consent to the use of any and all photographs, video, and audio recordings of myself and my Participant for use in promotional and educational projects by Horizon Community Church & School.  I understand that this is consent given without any expectation of compensation to me or the Participant, and that all photographs, videos, and recordings shall become the property of Horizon Community Church & School.

Liability: I acknowledge that participation in the Activity described above involves risk to the Participant (and to Participant’s parents or guardians, if Participant is a minor), and may result in various types of injury including, but not limited to, the following: sickness, personal injury, death, emotional injury, property damage, and/or other financial damage. In consideration for the opportunity to participate in the Activity described above, the Participant (or parent/guardian if Participant is a minor) acknowledges and accepts the risks of injury associated with participation in and transportation to and from the Activity. The Participant (or parent/guardian) accepts personal financial responsibility for any injury or other loss sustained during the Activity or during transportation to and from the Activity, as well as for any medical treatment rendered to the Participant that is authorized by Horizon personnel or its agents, employees, volunteers, or any other representatives. Should it become necessary for the Participant to receive medical treatment for any reason, it is understood that the Participant’s insurance is responsible for the primary costs of all care provided and that any insurance provided by Horizon is secondary. The Participant (or parent/guardian) accepts full responsibility for the excess costs of medical treatment for any injury which is over and above that which is covered by insurance.

Further, the Participant (or parent/guardian), understanding the inherent risks of the Activity, releases and promises to indemnify, defend, and hold harmless the Horizon Community Church/Christian School/Learning Center, and its agents, employees, volunteers, or any other representatives, for any injury or loss arising directly or indirectly out of the described Activity or transportation to and from the Activity, whether such injury arises out of the negligence of the Activity Sponsor, the Participant, or otherwise, except in the case of gross negligence as may be determined.

Arbitration: If a dispute over this agreement or any claim for damages arises, the Participant (or parent/guardian) agrees to resolve the matter through a mutually acceptable alternative dispute resolution process. If the Participant (or parent/guardian) and the Activity Sponsor cannot agree upon such a process, the dispute will be submitted to a three-member arbitration panel for resolution pursuant to the rules of the Arbitration Service of Portland, Inc.

By your signature you are agreeing to the terms and conditions of our Participation Agreement.

Is participant 18 or older? *
Parent/Guardian Signature: *
Student Signature (if 18 or older): *
Please select a Camp T-Shirt size: *