Family Application Form

I acknowledge that I will be participating in a family retreat at Camp John Marc in Meridian, Texas, and that utilizing the various transportation, facilities, activities and equipment of Camp John Marc in Meridian, Texas carries with it the potential for personal injury. I hereby assume the risk of utilizing such facilities and equipment and I certify that I am sufficiently physically fit to participate in such activities.

I, for myself and for my executors, administrators, heirs, next of kin, successors, and assigns, and anyone else who might claim or sue on my behalf, do hereby waive, release, and discharge from any and all claims, losses, or liabilities for death, personal injury or sickness, partial or permanent disability, property damage, medical or hospital bills, or damage of any kind arising out of my participation in or utilization of the transportation, facilities, activities and equipment, Camp Sol, Inc., Children’s Medical Center of Dallas, and Camp John Marc, and their respective shareholders, owners, directors, officers, employees, agents, and representatives, regardless of whether such claims, losses, or liabilities are caused by the negligent acts or omissions of any other person or entity.

I promise and agree not to sue any of the persons or entities mentioned above for any of the claims, losses, or liabilities that I have waived, released, or discharged herein and I agree to indemnify and hold harmless the persons or entities mentioned above from any and all claims made or liabilities assessed against them as a result of (a) my actions or inactions, (b) the actions or inactions or negligence of others including those parties hereby identified or (c) the conditions of the facilities and equipment or (d) any other harm caused by, or related to my using the transportation, facilities and equipment, or participating in any activities.

The undersigned (whether one or more) has represented and does represent that I am the parent or the guardian or the managing or possessory conservator of the below named minors (“the child(ren)”) and hereby consent to the participation of the child(ren) in the family retreat. The undersigned does hereby agree to indemnify and hold harmless, Camp Sol, Inc., Children’s Medical Center of Dallas, and Camp John Marc and those persons or entities above-described from and against any and all claims, liabilities, losses, personal injury, disability, or medical or hospital bills of such minor or minors to the full extent described herein.

I expressly agree that the foregoing acknowledgment, waiver, and release from liability is intended to be as broad and inclusive as is permitted by the laws of the State of Texas and if any portion hereof is held invalid, the balance shall continue in full force and effect.

I hereby affirm that I am eighteen (18) years of age or older, that I have read this document and understand its contents, and that I voluntarily sign this document without any oral representation or statements having been made to induce me to sign this document.

I certify that I am the participant or the legal representative/parent of the minor participating, and I hereby authorize Camp Sol Inc. to interview me and/or my child(ren), and/or to have photographs, audio or audiovisual recordings, collectively referred to as “images” made of me/my child. I authorize Camp Sol to release images to the news media or the general public through broadcast, print or the Internet. I authorize Camp Sol to release my/my child(ren)’s images to the news media or the general public for the following purposes: general publicity/marketing and fund-raising (through, to or by brochures, fliers, posters, other collateral materials and organization publications); news releases (through, to or by TV, radio, print or electronic media, the Camp Sol Internet site). I understand this authorization is voluntary and I may refuse to sign. I understand that my/my child(ren)’s images may no longer be protected by state and federal privacy laws once they are disclosed and, therefore, may be subject to redisclosure by the news media, general public or other third parties.

I understand that Camp Sol may not condition participation on the completion of this authorization.

I understand that I may revoke this authorization at any time, except to the extent that Camp Sol has relied on this authorization, by sending a written statement of revocation that specifically refers to this authorization to:

Camp Sol Inc.
P.O. Box 140589
Dallas, Texas 75359

I hereby release Camp Sol, its board, officers and agents from any and all liability connected with the capture, use or release of this media information and/or images. By signing this authorization, I acknowledge that I have read and understand the statements contained herein. I understand that Camp Sol will provide me with a copy of this signed authorization form upon request.