Activity Waiver

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Activity Waiver Release of Liability, Assumption of Risk, and Indemnification Agreement This document affects your legal rights: Read carefully before signing. The undersigned is the participant or the legal guardian of a minor child who desires to engage in certain activities at Black Lake Bible Camp and Conference Center (“BLBC”). On behalf of myself (“Guardian”), and my minor child (“Camper”), I hereby waive the rights described below and release BLBC from liability related to the activities described herein. 1. ACTIVITY AND ASSOCIATED RISKS: Guardian has chosen to allow Camper to participate in activities on the Climbing Wall (the “Activity”), which is provided by Black Lake Bible Camp & Conference Center (“BLBC”). Guardian understands, acknowledges and agrees that: a. The Activity is inherently dangerous and hazardous, and Camper may be exposed to dangers, hazards, and physical and mental trauma, including without limitation the following: bruises, punctures, damage to eyes, ears or mouth, damage to organs, lesions, falls, fractures, concussions, impacts, collisions with other participants, overexertion, overheating, rope abrasion, entanglement, dropped items, injuries from my lack of fitness or conditioning, death, equipment failures, and negligence of others. b. As a consequence of these risks, Camper may be seriously hurt, disabled, or may die from the resulting injuries, and my property may also be damaged. c. Hospital facilities, qualified medical care, and medical evacuation may be limited by local conditions; and d. BLBC assumes no responsibility for providing medical care during Activity, and Guardian shall be solely responsible to pay for any medical care and/or evacuation that Camper incurs. 2. ASSUMPTION OF THE RISKS: Guardian agrees that Camper’s participation in the Activity is entirely voluntary and on Camper’s behalf freely assume the above-mentioned risks and any harm, injury or loss that may occur as a result of Camper’s participation in the Activity – including any injury or loss caused by the negligence of BLBC, its employees and officers, its contractors, and other participants. Guardian also understand that any equipment provided by BLBC or any other person is provided without any warranty about its condition or suitability. 3. RELEASE OF LIABILITY: Guardian, for Guardian and on behalf of Camper, hereby waives any claims against and releases BLBC, its agents, employees, contractors and suppliers from, any liabilities, claims, causes of action, or expenses (including attorney fees) that arise from or are related in any way to injuries or damages, of any kind or any nature, resulting from the Activity. 4. INDEMNIFICATION. Guardian shall indemnify and hold harmless BLBC from and against any and all claims, causes of action, expenses (including attorney fees and costs), liabilities and/or obligations that arise out of or are related in any way to Camper’s participation in the Activity. 5. AUTHORITY. Guardian represents and warrants that Guardian has the legal authority to execute this document and to act on behalf of Camper. Check activities participating in:  Climbing Wall ________(Initial)

___________________________________ Parent/Responsible Adult Signature

 Archery Tag ________ (Initial)

______________ Date

 Paintball ________ (Initial)

_____________________________________ Print Participant’s Name

___________________________________ Parent/Responsible Printed Name

______________________________________ Participant’s Date of Birth

___________________________________ Relationship to Participant

______________________________________ Camp/Group/Church Name

Black Lake Bible Camp | 6521 Fairview Rd SW, Olympia, WA 98512Phone: (360) 357-8425 | Fax: (360) 357-4438 | blbcOlympia.com