RC Activities Release Form: 18+ years
2018-2019 RC Activities, Inc.
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  • 2. NATURE AND DURATION OF ACTIVITIES 2016-17

    October 5-7, December 7-9, February 22-24, April 5-7, May 31-June 16. Camp activities include: outdoor sports, dynamics, team building, leadership talks, guided prayer.
    @ Bocamb Farms, 81495 hwy 437, Covington LA.
  • 3. ACTIVITY SUPERVISOR(S)

    Legionary priests and certified adult chaperones
  • 4. TRANSPORTATION

    Not Applicable. Participants are responsible for securing their own transportation to and from activities, as the company does not provide transportation.
  • 5. REQUIREMENTS

    The participant named above is in good health and has no physical or medical limitations that would cause the activities described above to be detrimental or dangerous to the participant. Specific allergies and medical problems should be indicated in section 9 below.
  • 7. CONSENT

    The above-named participant certifies that he is above the age of majority and hereby consents to participate in the activities described above and specifically requests that he be allowed to participate in those activities.
  • 8. AUTHORIZATION

    The above named participant hereby authorizes RC Activities, Inc. to use the image and likeness of him/her in photograph or video form whether taken by or commissioned by RC Activities, Inc. in its promotional materials and for its promotional purposes associated with its nonprofit activities. This authorization shall extend to use of his/her image and likeness on website of RC Activities, Inc. or its successor in operation or affiliated organization(s) upon written consent of RC Activities, Inc. The above named participant understands that this authorization shall survive the end of his/her participation in the activities referenced on this form.
  • 9. INSURANCE

    The above named participant understands that RC Activities, Inc. does not carry any insurance relative to the activities or for any injury that may occur to him/her. The above named participant represents that he she is (a) covered by insurance through his/her own insurance carrier; or (b) that he/she is personally financially responsible for any and all medical costs incurred as a result of injury.
  • 10. EMERGENCIES

    If the above-named requires any emergency medical procedures or treatments during the activities, he consents to the activity supervisor(s) taking, arranging for or consenting to such procedures or treatments in the discretion of the activity supervisor(s). For purposes of such procedures and treatments, the participant's allergies or other medical problems (if any) are listed below:
  • 11. EMERGENCY CONTACTS

    If, in the event of a medical or other emergency, the above named participant authorizes the activity supervisor(s) to attempt to contact emergency contacts through the alternative emergency contacts listed below.
  • Relation
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    Phone
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    Alternate Phone
  • Alternative Emergency Contact Information

  • Relation
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    Phone
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    Alternate Phone
  • 12. RELEASE AND INDEMNIFICATION

    I release and waive, and further agree to indemnify, hold harmless or reimburse RC Activities, Inc. and Consolidated Catholic Administrative Services, Inc., the individual members, agents, directors, officers, employees, volunteers and representatives thereof, as well as activity supervisors, from and against, any claim which I, any parent or guardian, any sibling, or any other person, firm or corporation may have or claim to have, known or unknown, directly or indirectly, for any losses (including attorneys’ fees incurred by RC Activities, Inc. and Consolidated Catholic Administrative Services, Inc., or any of its individual employees, agents, volunteers, etc. in enforcing this indemnity provision) without limitation in time or amount, damages or injuries arising out of, during, or in connection with my participation in the activities, the travel to and there from, and the rendering of emergency medical procedures or treatment, if any. I understand that this release and indemnification shall survive the end of my participation in the activities referenced on this form and shall have no limitation in time or amount.
  • 13. BOCAMB INSURANCE

    I understand that Bocamb Farm does not carry any insurance relative to the activities or for any injury that may occur to me. I am covered by insurance through my own insurance carrier.
  • 14. BOCAMB RELEASE AND INDEMNIFICATION

    I release and waive, and further agree to indemnify, hold harmless or reimburse Bocamb Farm against any claim which I or any other person, firm or corporation may have or claim to have, known or unknown, directly or indirectly, for any losses (including attorneys’ fees incurred by Bocamb Farm or any of its owners, employees, agents, volunteers, etc. in enforcing this indemnity provision without limitation in time or amount, damages or injuries arising out of, during, or in connection with my participation in the activities, the travel to and there from, and the rendering of emergency medical procedures or treatment, if any. I understand that this release and indemnification shall survive the end of my participation in the activities at Bocamb Farm referenced on this form.
  • By completing and submitting this Agreement and checking the “I agree” box, you are consenting to the terms and provisions, as well entering into this Agreement in electronic form. You hereby agree that the accompanying electronic signature is valid for all purposes, as defined by law.