Author: Owner

Activity Participation Agreement
ACTIVITY INFORMATION - CEF Walk-a-Thon 2022, Canoe Creek State Park, 205 Canoe Creek Rd, Hollidaysburg, PA 16648. Sponsored by CEF (Child Evangelism Fellowship), 512 Logan Blvd., FL 1, Altoona, PA 16602, (814) 942-5222
PARTICIPANT INFORMATION (TO BE COMPLETED BY PARTICIPANT OR AUTHORIZED GUARDIAN)
Name of participant: ______________________________________________________________________________
Name of parents/guardians: ________________________________________________________________________
Address:___________________________ Phone:_____________ Name of emergency contact: ___________________
Phone (daytime):_____________________________ Phone (evening):_______________________________________
List allergies or medical conditions: ___________________________________________________________
Is sponsor authorized to approve medical treatment? Yes No
Is participant covered by personal/family medical insurance? Yes No
If yes, name of insurer: _____________________________________________________________________
Policy or group number: ____________________________________________________________________
PARTICIPATION AGREEMENT I acknowledge that participation in the activity described above involves risk to the participant (and to the participant’s parents or guardians, if the participant is a minor), and may result in various types of injury including, but not limited to, the following: sickness, exposure to infectious/communicable disease, bodily injury, death, emotional injury, personal injury, property damage, and financial damage.
In consideration for the opportunity to participate in the activity described above (the “activity”), the participant (or parent/guardian if the participant is a minor) acknowledges and accepts the risks of injury associated with participation in the activity. The participant (or parent/guardian) accepts personal financial responsibility for any injury or other loss sustained during the activity, as well as for any medical treatment rendered to the participant that is authorized by the sponsor or its agents, employees, volunteers, or any other representatives (collectively referred to as the “activity sponsor”). Further, the participant (or parent/guardian) releases and promises to indemnify, defend, and hold harmless the activity sponsor for any injury arising directly or indirectly out of the described activity, whether such injury arises out of the negligence of the activity sponsor, the participant, or otherwise.
If a dispute over this agreement or any claim for damages arises, the participant (or parent/guardian) agrees to resolve the matter through a mutually acceptable alternative dispute resolution process. If the participant (or parent/guardian) and the activity sponsor cannot agree upon such a process, the dispute will be submitted to a three-member arbitration panel for resolution in accordance with the rules of the American Arbitration Association.
Signature: ___________________________________Date: _______________________________________
Sat. October 23, 2021, cefdelco.com Ridley Creek State Park, Pavilion 17, 5K (3 mile)
Walk to win kids for Christ