High School Retreat
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Acknowledgement of Inherent Risk*

I RELEASE PROVIDENCE CHURCH, INCLUDING ITS EMPLOYEES, AGENTS AND TRUSTEES, FROM RESPONSIBILITY FOR MY ACCIDENTAL PHYSICAL INJURY, INCLUDING DEATH OR ILLNESS, AND LOSS OF PERSONAL PROPERTY WHILE AT CAMP OR DURING PROVIDENCE CHURCH SPONSORED TRAVEL TO AND FROM CAMP. THIS RELEASE IS ALSO INTENDED TO INCLUDE ALL CLAIMS MADE BY MY FAMILY, ESTATE, HEIRS, PERSONAL REPRESENTATIVE OR ASSIGNS. I GRANT PERMISSION FOR MY CHILD TO PARTICIPATE IN ALL SPECIAL TRIPS OFF THE CAMP PROPERTY WITH PROPER STAFF SUPERVISION.

Amount: $100

Please mail a check to Providence Church, 430 Hannum Ave, West Chester PA 19382 or make a payment to Ryan Enns. Checks should be made payable to Providence Church

 

© 2017 Providence Church | West Chester   |   430 Hannum Ave, West Chester, PA US 19382