May 10-11, 2024 Youth Retreat

Contact Details

Name(Required)
Email(Required)
Address
Emergency Contact(Required)
Medical Insurance Information(Required)

Medical Treatment Authorization:

In the event of a medical emergency, I hereby give permission to the medical personnel selected by the staff or volunteers of the NewLife Youth Retreat held at Immanuel OP Church in Bellmawr, NJ on May 10-11, 2024 (from here referred to as “the event”) to secure and administer treatment, including hospitalization, order X-rays, routine tests, and transportation as deemed necessary for me/my child(ren).

Assumption of Risks:

Participation in this event carries with it certain inherent risks that cannot be eliminated regardless of the care taken to avoid injuries. The specific risks vary from one activity to another, but the risks range from (1) minor injuries such as scratches, bruises, and sprains (2) major injuries such as eye injury or loss of sight, joint or back injuries, heart attacks, and concussions to (3) insect bites, parasites, and other diseases, to (4) catastrophic injuries including paralysis and death. I know, understand, and appreciate these and other risks that are inherent in the event. I hereby assert that my/my child(ren)’s participation in the event is voluntary and that I/they knowingly assume all such risks.

Indemnification and Hold Harmless:

I also agree to INDEMNIFY, DEFEND, AND HOLD the Presbytery of Philadelphia (OPC), Covenant OP Church, and the staff and volunteers of this event HARMLESS from any and all claims, actions, suits, procedures, costs, expenses, damages and liabilities, including attorney’s fees brought as a result of my/my child(ren)’s involvement in the event and to reimburse them for any such expenses incurred. I understand that there are risks inherent in the event and I agree to hold the Presbytery of New Jersey (OPC), Immanuel OP Church, and the staff and volunteers of this event blameless in all instances.

Transportion:

Should it become necessary for me/my child to return home for medical or disciplinary purposes, I will arrange for transportation at my expense within four hours of the request.

Photos:

I hereby give permission to the NewLife Youth Retreat to use photographs of me/my child(ren) taken by the official photographer(s) for promotional uses related to future retreats.
I have read and understand the terms as stated above and by clicking 'submit' I agree to these terms:(Required)

Payment: $30 per Registrant

Upon Clicking ‘Submit’ you will be redirected to Faith OPC’s (Pole Tavern, NJ) website for payment.

Medical Treatment Authorization:

In the event of a medical emergency, I hereby give permission to the medical personnel selected by the staff or volunteers of the NewLife Youth Retreat held at Immanuel OP Church in Bellmawr, NJ on May 10-11, 2024 (from here referred to as “the event”) to secure and administer treatment, including hospitalization, order X-rays, routine tests, and transportation as deemed necessary for me/my child(ren).

Assumption of Risks:

Participation in this event carries with it certain inherent risks that cannot be eliminated regardless of the care taken to avoid injuries. The specific risks vary from one activity to another, but the risks range from (1) minor injuries such as scratches, bruises, and sprains (2) major injuries such as eye injury or loss of sight, joint or back injuries, heart attacks, and concussions to (3) insect bites, parasites, and other diseases, to (4) catastrophic injuries including paralysis and death. I know, understand, and appreciate these and other risks that are inherent in the event. I hereby assert that my/my child(ren)’s participation in the event is voluntary and that I/they knowingly assume all such risks.

Indemnification and Hold Harmless:

I also agree to INDEMNIFY, DEFEND, AND HOLD the Presbytery of Philadelphia (OPC), Covenant OP Church, and the staff and volunteers of this event HARMLESS from any and all claims, actions, suits, procedures, costs, expenses, damages and liabilities, including attorney’s fees brought as a result of my/my child(ren)’s involvement in the event and to reimburse them for any such expenses incurred. I understand that there are risks inherent in the event and I agree to hold the Presbytery of New Jersey (OPC), Immanuel OP Church, and the staff and volunteers of this event blameless in all instances.

Transportion:

Should it become necessary for me/my child to return home for medical or disciplinary purposes, I will arrange for transportation at my expense within four hours of the request.

Photos:

I hereby give permission to the NewLife Youth Retreat to use photographs of me/my child(ren) taken by the official photographer(s) for promotional uses related to future retreats.