PARENT/ LEGAL GUARDIAN’S STATEMENT OF PARTICIPATION, ASSUMPTION OF RISK, AND RELEASE OF LIABILITY

1. ACKNOWLEDGMENT OF INHERENT RISKS
I certify that I am aware of the inherent risks associated with outdoor camp activities, as well as the inherent risks of being on camp property. Notwithstanding, I hereby give my child permission to participate in all camp activities. Further, in consideration for Mt. Lebanon agreeing to accept the above named child as a camper, I hereby personally assume all risks in connection with my child’s attendance and participation in the events at Mt. Lebanon. 

2. ACKNOWLEDGEMENT OF FINANCIAL RESPONSIBILITY
In the event that my child is injured on camp property or during camp activities, I acknowledge that I shall be personally liable for, and agree to pay, all costs and associated expenses incurred in connection with medical and/or dental services rendered to my child in response to said injury. 

3. LIMITATIONS ON INSURANCE COVERAGE
I understand that my family/personal health and accident insurance will be the primary coverage. 

4. RELEASE AND HOLD HARMLESS AGREEMENT
I agree to release and hold harmless the Dallas Baptist Association, Mt. Lebanon Encampment, it’s trustees, employees, agents, and representatives for any injury, harm, or other damage by any occurrence in connection with my child’s participation in camp activities in any form or fashion. I further agree to release and hold harmless Dallas Baptist Association, Mt. Lebanon Encampment, it’s trustees, employees, agents, and representatives from any claim by me, or my family, estate, heirs or assigns out of my child’s participation in activities at Mt. Lebanon. 

5. PRE-AUTHORIZATION FOR MEDICAL TREATMENT
I hereby authorize any medical and/ or surgical treatment, including but not limited to hospital care, to be rendered to my child, as needed in the judgment of the treating physician, who is chosen by the Camp Director or any employee working under him/her, as circumstances require. I further authorize the Mt. Lebanon health staff to render first-aid and to administer medications as prescribed and programmed on the Dosage & Frequency Chart, executed by the parent or guardian. 

6. ACKNOWLEDGMENT OF RESPONSIBILITY FOR DAMAGES
I agree that I am financially responsible for any damage to camp property caused by my child, including any acts of graffiti. 

7. CONSENT TO ADDRESS DISCIPLINARY PROBLEMS The above named camper agrees to obey and observe all camp rules, and to fully cooperate with the adult leadership, camp staff, and other campers.
I agree that, if in the judgment of the adult leadership and/ or camp staff, my child becomes a discipline problem, my child may be sent home, at my expense, and that I will forfeit all camp fees paid. 

8. USE OF CHILD’S PHOTOGRAPH FOR PROMOTIONAL PURPOSES
I agree and consent that my child’s photograph may be used for promotional purposes or publicity material by Mt. Lebanon.