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LIABILITY WAIVER & PHOTO/VIDEO RELEASE

In consideration of my child being given the opportunity to participate in Camp Spirit of the Game (the
Activity), I, for myself, my personal representatives, assigns, heirs, and next of kin:
1. Acknowledge, agree and represent that I understand the vigorous, physical nature of Ultimate
Frisbee, SWIMMING, and related camp activities, and affirm that my child is in good health, in proper
physical condition, and able to participate in such Activity.
2. Fully understand that: (a) Ultimate, swimming and other sports and games involve risks and dangers
of bodily injury, including permanent disability and death ("Risks"); (b) these Risks and dangers may
be caused by my son or daughters actions, his or her inactions, the actions or inactions of others
participating in the Activity, the condition in which the Activity takes palace, or the negligence of the
Releasees named below; (c) there may be other risks and social and economic losses either not known
to me or not readily foreseeable at this time; and I:
3. FULLY ACCEPT AND ASSUME ALL SUCH RISKS AND ALL RESPONSIBILITY FOR LOSSES,
COSTS AND DAMAGES incurred as a result of my childs participation in the Activity.
4. Hereby release and covenant not to sue Camp Spirit of the Game, its founder, organizers,
administrators, directors, agents, officers, volunteers, employees, sponsors, or the owners and lessors
of premises on which the Activity takes place (the Releasees), from all liability, claims, demands,
losses or damages on my account caused or alleged to be caused in whole or in part by the negligence
of the Releasees or otherwise, including negligent rescue operations. I further agree that if, despite this
release and waiver of liability, assumption of risk, and indemnity agreement, I, or anyone on my
behalf, makes a claim against any of the Releasees, I will indemnify, release and hold harmless each of
the Releasees, from any litigation expenses, attorney fees, loss, liability, damage, or cost which may
incur as a result of such claim.
5. GRANT PERMISSION for Camp Spirit of the Game (Company) and any person, firm, or
corporation the Company might assign to use my childs likeness in promotional photographs and/or
videos, including online distribution (e.g., YouTube), without payment, royalties, or any other
consideration. The Company may edit, alter, copy, exhibit, publish or distribute the photos and/or
videos for any lawful purpose without my inspection. Additionally, I acknowledge that the Company
shall be the sole and exclusive owner of all rights to the photos and/or videos, including, without
limitation, the copyright.
I have read this agreement, fully understand its terms, and understand that I have given up substantial
rights by signing it. I have signed it freely and without any inducement or assurance of any nature and
intend it be a complete and unconditional release of all liability to the greatest extent allowed by law. I
agree that if any portion of this agreement is held to be invalid, the balance, notwithstanding, shall
continue in full force and effect.
The Releasees covered by this waiver include:
Camp Spirit of the Game, its employees, officers, owners, counselors and other agents;
La Roche College, the Sisters of Divine Providence, the Congregation of Divine Providence of
Allegheny County and its members, agents, representatives and employees;
Allegheny County, the City of Pittsburgh, their respective Parks and Recreation departments,
elected officials and employees.
Name of Participant: ________________________________________________________
Printed Name of Parent/Guardian: _______________________________________
Parent/Guardian Signature___________________________ Date: ____________________

MEDICAL RELEASE

As the parent(s) or legal guardian(s) of ____________________________________, I/we do hereby


appoint the agents and staff of Camp Spirit of the Game to act in my/our behalf in authorizing unexpected
medical care, dental care, and/or hospitalization for the above named minor(s).

Name: _________________________________ Emergency Phone: ________________________


Signature: _________________________________________ Date: ________________________

Name: _________________________________ Emergency Phone: ________________________


Signature: _________________________________________ Date: ________________________

Please list your childs Allergies and Special Medical Conditions, and any special measures or
precautions you would like us to take:
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________

Name of Medical Insurance Company: ________________________________________


Policy/Group ID Number: ____________________________________________
Primary Policy Holders Name: _____________________________________________
Family Physician:_______________________________Physician phone #:___________________