WAIVER, MEDIA RELEASE, AND HEALTH RECORD
General Waiver
My child, _____________________________________, is not yet 18 years old and will participate in Southern Adventist
University’s (“University”) Academic Summer Camp June 18-20, 2018, (the “Program”). Activities may include,
but are not limited to: classroom projects, on-campus recreation, off-campus trips, and overnight lodging.
This document (“Agreement”) covers all aspects of my child’s participation in the Program. In this Agreement,
“University” means Southern Adventist University, its trustees, officers, employees, trainees, students, volunteers,
and agents.
I understand that participation in the Program involves risks that the University cannot eliminate, including,
among others, risk of personal property damage, illness, bodily injury, permanent disability, and death. I
voluntarily assume all risks of my child’s participating in the Program and release and discharge the University
from all legal and financial responsibility for any harm that I, my child, or our property might suffer as a result of
my child’s participation.
If the University is held financially responsible to the undersigned for any such incident, injury or accident, I
hereby agree to indemnify and hold the University harmless from any such responsibility, including costs,
damages, and attorney’s fees incurred by the University.
Notwithstanding the foregoing, nothing contained herein shall absolve the University from liability for injury
arising out of the gross negligence or intentional misconduct of the University.
I attest that my child has adequate health insurance coverage during the period referenced above and will cover
him/her without restrictions on location of where he/she is being treated.
I agree that I have read and understood this Agreement, I am competent to sign it, and I do so voluntarily and
without relying on anything the University wrote or told me, except what is written above. I understand that I am
free not to sign this Agreement and to find a different program for my child.
Before you sign this agreement, please read it carefully because it affects your legal rights.
Parent/Legal Guardian Name: _____________________________________________ Today’s Date: ___________________
Child’s Name: __________________________________________________ Child’s DOB: _____________
Media Release
I give permission for photographs and/or video of _____________________________ (student's name) to be taken
during camp activities. I further consent that any such images may be published and used by Southern Adventist
University and its agents to illustrate and promote the camp experience. I further give permission for any creative
work produced by the student to be published by Southern to illustrate and promote the camp experience.
I DO NOT give permission for photographs and/or video of my student or his/her work to be used.
Parent/Legal Guardian Name: _____________________________________________ Today’s Date: ___________________
