INDEPENDENT PRESBYTERIAN CHURCH SKI TRIP 2016 MINOR RELEASE OF LIABILITY, INDEMNITY AGREEMENT, AND CONSENT TO MEDICAL TREATMENT
I hereby authorize IPC and its staff, employees, volunteers, agents, and third party contractors to provide necessary transportation, food, and lodging for my child’s participation. In the event of a medical emergency, I understand that IPC will make reasonable efforts to contact me or my child’s emergency contacts, however: (1) I authorize IPC and its staff, employees, or volunteers to administer first aid or CPR to my child, if they think it is necessary; (2) I authorize IPC and its staff, employees, or volunteers to administer appropriate medication to my child if they deem it necessary, except for any medications I have listed below, to call for emergency treatment, if necessary, to transport my child to a medical treatment facility, and to consent, if I or the emergency contacts cannot be reached, to xrays, medical or dental examination, diagnosis, treatment, or hospital care, including emergency surgery, as advised by the treating physician, surgeon, or dentist; and (3) I authorize IPC and its staff, employees or volunteers to disclose any relevant medical information about my child as necessary for his/her treatment. I understand that I will be solely responsible for any medical, hospital or related charges, which may be incurred, on behalf of my child in connection with any injury, illness or other medical condition suffered by him/her during these trips or activities. Upon request, I will reimburse IPC for any charges paid by them on my child’s behalf. I also authorize IPC, its staff, employees, and volunteers to photograph or digitally record images of my child and to record my child’s voice during his/ her participation and I authorize IPC to use such photos, images or recordings for any purpose relating to the IPC youth ministry. I waive any and all privacy or intellectual property rights I or my child may have with respect to any such photos, images, or recordings, and release IPC and its directors, officers, staff, employees, volunteers, agents, and third party contractors, from any and all legal claims, demands, or causes of action, of any nature whatsoever, relating to photos, images, or recordings taken of my child pursuant to this authorization. NAME OF PARTICIPANT (Please Print)____________________________________________ AGE: _______ THE UNDERSIGNED HAS READ AND AGREES TO BE BOUND BY THIS RELEASE OF LIABILITY, INDEMNITY AGREEMENT, AND CONSENT TO MEDICAL TREATMENT: Father/Mother/Legal Guardian: _______________________________ Date: _____________________ The undersigned states on oath that he or she is the parent (custodial parent if divorced or separated) or legal guardian of the Participant and intends to be bound by this signature.
4738 Walnut Grove Road Memphis, TN 38117
I hereby give my permission for my child to participate in Ski Trip 2016. I certify that my child is healthy and capable of participating, or I have communicated any medical conditions of which Independent Presbyterian Church (“IPC”) should be aware that may hinder my child’s participation. I understand that it is solely my responsibility to determine if there is any medical reason that my child should not participate. In consideration for IPC allowing my child to participate, I hereby, on behalf of myself and on behalf of my minor child, release, discharge, waive my right to sue, and agree to indemnify and hold harmless IPC, its directors, officers, staff, employees, volunteers, agents, and third party contractors, from any and all legal claims, liabilities, losses, expenses and demands of any nature whatsoever, including those related to personal injury, sickness, harm, death, or property damages suffered by my child or me as a result of, or arising in any way out of, my child’s participation. Furthermore, I acknowledge that there are risks involved in participating, and I hereby, on behalf of my minor child, assume all risk of personal injury, sickness, death, damage and expense arising out of or related to my child’s participation.
DECEMBER 27 – 31 IPC SENIOR HIGH
Q & A
HOW DO I REGISTER? Signing up is a two-step process:
WHO CAN GO? This trip is designed for any student currently in 9th through 12th grade.
WHAT IS THE COST? The base cost of the trip is $1075, which includes round-trip airfare, bus travel throughout the course of the week, four nights of lodging at YMCA’s Snow Mountain Ranch, three days of breakfast and dinner, three days of lift tickets/basic ski rentals (including a helmet). A $300 deposit is required in order to sign-up. The remaining balance will then be due by Wednesday, November 30, at the parent meeting. Note: Because of the cost of name changes on flights, all payments are nonrefundable. (Trip insurance is available through skidaddy.com.)
The trip cost DOES NOT include: Lunches While we will provide breakfast and dinner each day, students will need to be prepared to purchase four lunches throughout the week. Given that they will be eating at the airport/ski resort, which tend to be a bit more expensive, a minimum of $75 in spending money is necessary.
1. Go to www.skidaddy.com/indepres, and complete all of the required information under “sign-up” and then submit your request to join the trip. You will also be directed to a “release of liability and waiver” form for the ski resort that you will need to complete.
WHEN SHOULD WE SIGN-UP? We have only a set amount of space reserved for this trip, and therefore, students are encouraged to act quickly to reserve their spot. Once those spots are reserved, we will then begin compiling a waiting list.
SKI TRIP PARENT/STUDENT MEETING
2. Then remove the medical/liability release form from this brochure, fill it out, and send it to
Participating students and at least one parent/ guardian should be in attendance for a meeting on Wednesday, November 30, from 5:40–6:20 p.m. in the Senior High space.
Independent Presbyterian Church, SKi IPC 4738 Walnut Grove Road Memphis, TN 38117
FUNDRAISING/JOB OPPORTUNITIES/ SCHOLARSHIPS
We will need a medical/liability release form for every student attending this trip. Included with this form should be a $300 deposit, payable to IPC, with the student’s name written in the memo line. This deposit should not be placed in the offering plate. We also need a personal/ contact information form if we don’t already have one on file for your student (i.e., your student hasn’t attended a trip with us during 2016). This form can be found at www.indepres. org/ministries/ senior-high/ski-trip.
If a student is interested in this trip, but money is a concern, we will look to provide several opportunities for our group to raise funds throughout the fall semester. In addition to these opportunities, for students who are willing to work, we will seek out opportunities within our congregation to make money for the trip. For more information, contact Justin Jones at 901.685.8206 or justinjones@ indepres.org.
Ski Lessons Anyone is welcome to take a lesson, but if you have never skied (or snowboarded) before, you are REQUIRED to take a lesson. This will be included in your total balance due to IPC. The cost of a lesson is $89/day. It is a full day and includes your lunch. Ski or Snowboarding Upgrades A snow board rental is $5/day; performance snowboard or skis are $17/day, high performance snowboard/skis are $21; and demo snowboard/ skis are $25/day. This will be added to your total balance due to IPC.
If you have questions, contact Justin Jones, 901.685.8206, justinjones@indepres.org