Burn- Youth Fall Retreat 2025 Burn Fall Retreat September 26-28, 2025Student Name(Required) First Last Student PhoneBiological Sex(Required)MaleFemaleStudent Grade(Required)6th7th8th9th10th11th12thPlease list students: allergies, medications and any physical restrictions.Students are allowed to keep over the counter medications with them such as Advil, Tums, Tylenol etc. All students will be required to turn in ALL prescription medications at check in. If your student is taking prescription medication without turning it in at check in, they may be asked to go home. Our heart is to care for all students needs to best of our ability for the weekend. Roommate Requests:Please list all people who are allowed to pick up your student from Doe River on Sunday September 28, 2025 at 12PM(Required)Parent Name(Required) First Last Parent Phone(Required)Parent Email(Required) My student is currently or will be 18 years old or older at the time of the event.(Required) Yes No Consent for Minor Student CF Waiver(Required) By checking this box I agree to the terms set forth in the Waiver below and confirms that I have read this information, understand it, and agree to be bound by it, and that my signed name below constitutes my legal digital signature.WAIVER, RELEASE, AND INDEMNIFICATION AGREEMENT FOR STUDENT MINISTRY EVENTS AND OTHER CHURCH RELATED ACTIVITIES SINGLE EVENT WAIVER This Waiver, Release, and Indemnification Agreement (the “Agreement”) is entered into as of the date signed below by the undersigned parent(s) or legal guardian(s) (“Parent/Guardian”) of the minor participant (the “Participant”) for the benefit of Christ Fellowship (the “Church”), its affiliates, officers, employees, agents, volunteers, representatives, and assigns (collectively, the “Released Parties”). By signing this Agreement, the Parent/Guardian consents to the Participant’s participation in the Church’s student ministry activity listed below for the duration of the event, and agrees to the terms and conditions set forth herein. I. SCOPE This Agreement applies to the Church-sponsored activity listed below. The activity may include but is not limited to: overnight camps, retreats, recreational programs, mission trips, transportation to and from events whether provided by the Church or by individuals, and all other activities organized for the purposes of student engagement and growth whether held on church property or off church property. This Agreement shall remain in effect for the duration of the event listed below. A new Agreement must be signed to participate in other events hosted by the Church. II. ACKNOWLEDGEMENT AND ASSUMPTION OF RISK The Parent/Guardian acknowledges and understand that participation in the listed activity involve inherent risks, including but not limited to: physical injuries, illness, accidents during recreational or overnight stays, transportation-related risks, unforeseen conditions on property or at facilities where the activity is being held, emotional risks, risks of medical complications, and other emergencies. The Parent/Guardian acknowledges that while the Church will make reasonable efforts to provide a safe environment, some risks are unavoidable. By signing this Agreement, the Parent/Guardian voluntarily assumes all such risks on behalf of the participant and agrees that participation is entirely voluntary. III. RELEASE, WAIVER OF LIABILITY, AND INDEMNIFICATION The Parent/Guardian, on behalf of the participant and themselves, fully release and discharge the Released Parties from any and all liability, claims, demands, caused of action, damages, and expenses (including attorney’s fees) arising from or relating to participation in the activity. This release includes, but is not limited to: injuries, property damage, loss sustained during the activity, emotional stressors in relation to participation, and incidental or consequential damages resulting from participation. The Parent/Guardian agrees to defend, indemnify, and hold harmless the Released Parties from any claims, causes of action, liabilities, or costs arising from: special, incidental or consequential damages, injury or loss caused by participant’s participation in the activity to others, parent/guardian’s breach of representations or obligations under this Agreement, and claims made by participant or their estate against the Released Parties. IV. MEDICAL CONSENT AND EMERGENCIES The Parent/Guardian hereby consents to the provision of first aid or emergency medical treatment for the participant in the event of illness or injury during the activity. In the event of an emergency and when the parent/guardian cannot be contacted, the undersigned Parent/Guardian authorizes a representative of the Church to consent to medical care for the Participant. The Parent/Guardian authorizes Church representatives to act as the Participant’s “personal representative” and to be treated as the Parent/Guardian would for all purposes of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and shall (1) have access to all of the Participant’s “individually identifiable health information,” including any “protected health information,” (2) possess, without limitation, the Parent/Guardian’s right of access to inspect and obtain a copy of protected health information about the Participant and (3) possess, without limitation, the Parent/Guardian’s right to an accounting of disclosures of protected health information. This authority hereby granted applies to any information governed by HIPAA. This grant of authority is limited to the time until the Parent/Guardian can be contacted, at which point the Church representative shall cease to be the Participant’s personal representative. It is understood that this authorization is given in advance of any special diagnosis, treatment, or hospital care being required, but it is given to provide authority and power on the part of the supervisor/church representative in the exercise of best judgment for the Participant’s care, upon advice by physician or other medical professional. The Church does not assume financial responsibility for medical treatment or related costs. The Parent/Guardian is encouraged to ensure the Participant is covered by adequate health insurance. If covered by health insurance, the Parent/Guardian agrees to provide insurance card and information in advance, should it ever be needed. V. PARTICIPANT CONDUCT The Parent/Guardian acknowledges that the Participant is required to adhere to all rules, regulations, and codes of behavior set forth by the Church. These rules are, but not limited to: respect for other participants, staff, and property, compliance with safety instructions and guidelines, and prohibition of unsafe or inappropriate behavior. Any violation of such rules may result in disciplinary action, including removal from the activity at the discretion of the Church. VI. PHOTOS, VIDEOS, MOTION PICTURES, AND RECORDINGS The Parent/Guardian grants full permission to the Church to use any photos, videos, motion pictures, recordings, and any other records or documents of the activity. No notice is required to be given to the Parent/Guardian and the Parent/Guardian will not be compensated for use of the photo for any purpose. VII. COST AND EXPENSES The Parent/Guardian assumes full responsibility for payment of the published and announced cost of the activity and agrees to pay that specified amount or any outstanding balance upon request by the Church. The Parent/Guardian assumes responsibility for any additional costs and expenses incurred by the Participant during the activity, including but not limited to: costs associated with medical care and other emergencies. VIII. GOVERNING LAW This Agreement shall be governed by and constructed in accordance with the laws of the State of Tennessee. Any dispute arising from or related to this Agreement or the activity shall be exclusively handled by the courts located in Tennessee. IX. ACKNOWLEDGEMENT AND SIGNATURE By signing below, the undersigned certifies that they are a parent/guardian of the Participant. The undersigned acknowledges that they have carefully read, understand this Agreement, and agree to its terms and conditions voluntarily and without reservation. The undersigned attest that the Participant is physically and mentally capable of participating in the activity outlined in this Agreement.Parent / Legal Guardian Signature(Required)Consent for Adult- CF Waiver(Required) By checking this box I agree to the terms set forth in the Waiver below and confirms that I have read this information, understand it, and agree to be bound by it, and that my signed name below constitutes my legal digital signature.WAIVER, RELEASE, AND INDEMNIFICATION AGREEMENT FOR MINISTRY EVENTS AND OTHER CHURCH RELATED ACTIVITIES SINGLE EVENT WAIVER This Waiver, Release, and Indemnification Agreement (the “Agreement”) is a legally binding agreement. Please read carefully before signing. Your participation in the Church’s programs and activities is conditioned upon acceptance of the terms and conditions of this Agreement. By signing below, you acknowledge that you have read this Agreement, understood, and agreed to the terms and conditions of the Agreement. I. PARTIES This Agreement is entered into between Christ Fellowship Church (the “Church”), including its officers, directors, employees, volunteers, agents, sponsors, affiliates, and all persons or entities acting on its behalf (collectively, the “Released Parties”) and an individual of or over the age of eighteen (18), or the parent(s)/guardian(s) on the behalf of a minor (collectively, the “undersigned’) II. SCOPE For the purposes of this agreement, the activities covered include all Church-sponsored events, outreach programs, overnight camps, retreats and associated activities (collectively, the “Activities”). The Agreement applies to participation in any and all Activities organized by the Church whether conducted on Church property or at an offsite location. Activities may include but are not limited to: overnight camps, retreats, recreational programs, mission trips, transportation to and from events whether provided by the Church or by individuals, and all other activities organized for the purposes of engagement, outreach and growth whether held on church property or off church property. This Agreement shall remain in effect for the duration of the below listed event for which this Agreement is signed. A new Agreement must be signed for participation in other, separate Activities hosted by the Church. III. ACKNOWLEDGEMENT AND ASSUMPTION OF RISK The undersigned acknowledges and understands that participation in the Activities involve inherent risks, including but not limited to: physical injuries, illness, accidents during recreational or overnight stays, transportation-related risks, unforeseen conditions on property or at facilities where activities are being held, emotional risks, risks of medical complications, and other emergencies. The undersigned acknowledges that while the Church will make reasonable efforts to provide a safe environment, some risks are unavoidable. By signing this Agreement, the undersigned voluntarily assumes all such risks and agrees that participation is entirely voluntary. I. RELEASE, WAIVER OF LIABILITY, AND INDEMNIFICATION The undersigned fully release and discharge the Released Parties from any and all liability, claims, demands, caused of action, damages, and expenses (including attorney’s fees) arising from or relating to participation in the activities. This release includes, but is not limited to: injuries, property damage, loss sustained during activities, emotional stressors in relation to participation, and incidental or consequential damages resulting from participation. The undersigned agrees to defend, indemnify, and hold harmless the Released Parties from any claims, causes of action, liabilities, or costs arising from: special, incidental or consequential damages, injury or loss caused by undersigned’s participation in the activities to others, breach of representations or obligations under this Agreement, and claims made by the undersigned or their estate against the Released Parties. I. MEDICAL CONSENT AND EMERGENCIES The undersigned hereby consents to the provision of first aid or emergency medical treatment in the event of illness or injury during the activities. In the event of an emergency which render the undersigned unable to make medical decisions and when the emergency contact cannot be contacted, the undersigned authorizes a representative of the Church to consent to medical care on their behalf. The undersigned authorizes Church representatives to act as the their “personal representative” and to be treated as the emergency contact would for all purposes of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and shall (1) have access to all of the undersigned’s “individually identifiable health information,” including any “protected health information,” (2) possess, without limitation, the right of access to inspect and obtain a copy of protected health information about the undersigned and (3) possess, without limitation, the right to an accounting of disclosures of protected health information. This authority hereby granted applies to any information governed by HIPAA. This grant of authority is limited to the time until the undersigned is able to make medical decisions independently or the emergency contact can be contacted, at which point the Church representative shall cease to be the undersigned’s personal representative. It is understood that this authorization is given in advance of any special diagnosis, treatment, or hospital care being required, but it is given to provide authority and power on the part of the supervisor/church representative in the exercise of best judgment for the undersigned’s care, upon advice by physician or other medical professional. The Church does not assume financial responsibility for medical treatment or related costs. The undersigned is encouraged to ensure access to adequate health insurance. If covered by health insurance, the undersigned agrees to provide insurance card and information in advance, should it ever be needed. I. PARTICIPANT CONDUCT The undersigned acknowledges that they are required to adhere to all rules, regulations, and codes of behavior set forth by the Church. These rules are, but not limited to: respect for other participants, staff, and property, compliance with safety instructions and guidelines, and prohibition of unsafe or inappropriate behavior. Any violation of such rules may result in disciplinary action, including removal from the Activity at the discretion of the Church. II. PHOTOS, VIDEOS, MOTION PICTURES, AND RECORDINGS The undersigned grants full permission to the Church to use any photos, videos, motion pictures, recordings, and any other records or documents of the Activities. No notice is required to be given and the undersigned will not be compensated for use of the photo for any purpose. III. COST AND EXPENSES The undersigned assumes full responsibility for payment of the published and announced cost of the Activities and agrees to pay that specified amount or any outstanding balance upon request by the Church. The undersigned assumes responsibility for any additional costs and expenses incurred during the Activities, including but not limited to: costs associated with medical care and other emergencies. IV. GOVERNING LAW This Agreement shall be governed by and constructed in accordance with the laws of the State of Tennessee. Any dispute arising from or related to this Agreement or the Activities shall be exclusively handled by the courts located in Tennessee. V. ACKNOWLEDGEMENT AND SIGNATURE By signing below, the undersigned certifies that they are the individual to participate in the Activities or they are a parent/guardian of the participant. The undersigned acknowledges that they have carefully read, understand this Agreement, and agree to its terms and conditions voluntarily and without reservation. The undersigned attest that the participant is physically and mentally capable of participating in the Activities outlined in this Agreement. Signature (must be signed by person attending)(Required)Signature (must be signed by person attending)(Required)Upload the FRONT side of your Insurance Card here:(Required)Max. file size: 200 MB. Upload the BACK side of your Insurance Card here:(Required)Max. file size: 200 MB. Burn- Youth Fall Retreat 2025 Price: Scholarship/Discount Code Total $0.00 Credit CardCard Details Cardholder Name
