Participant’s Name: ______________________________________________________________________ Group Name: ___________________________________
Guest Group RELEASE WAIVER
This form must be completed by ALL individuals attending Camp.
GENERAL RELEASE WAIVER:
I have asked Mile High Ministries (hereinafter “Camp”) to be allowed to participate in activities offered at Camp. Activities
may include but are not limited to: archery, rock climbing, low ropes course, gaga ball, sports, hiking, zip line, waterfront,
swimming. I acknowledge and understand that: (1) Camp activities involve physical exertion and other risks, (2) the possibility
of risk of injury to individuals participating or observing the activities, including but not limited to permanent disability
including blindness, or death does exist, (3) the need/requirement to participate in the activities in accordance with the rules
that are given and to follow directions given by Camp staff, (4) it is my responsibility to wear any and all safety gear deemed
necessary by Camp, (5) my physical and mental condition will enable me to participate safely in the activities. I waive and
release any and all claims, demands, actions, causes of action and rights (contingent, accrued, inchoate, or otherwise), defend,
and hold Camp harmless from and against any and all claims, liabilities, expenses, damages, losses, cause of action, and suits
(including, without limitation, attorney’s fees and costs) arising out of, or in any way related to my participation in activities at
Camp, whether caused by Camp’s active or passive negligence or otherwise. Initials: _____________
IMAGE RELEASE WAIVER:
I give my permission to Camp to use any photographs, video and audio of me for any promotional materials, including Camp
websites and social media postings, without expectation of compensation, including, but not limited to, any royalties,
proceeds, and/or other benefits derived from such photographs, videos, or audio recordings. Initials: _____________
MEDICAL RELEASE WAIVER:
I give Camp permission to provide or arrange necessary transportation, to secure and administer proper treatment as
needed, and to release any records necessary for insurance or care purposes. Camp may also give information as necessary
to all those who may be caring for me at camp. Initials: _____________
INFECTIOUS & CONTAGIOUS DISEASE WAIVER:
The novel coronavirus (COVID-19), is no longer a worldwide pandemic but is still around. As a result, federal, state, and local
governments and agencies recommend industry specific mitigation measures including but not limited to vaccination, mask
wearing, increased personal hygiene practices, and modified cleansing/sanitization procedures. Camp maintains compliance
with local and federal mandates to ensure guest safety, and has enacted preventative measures and programming
adjustments in response. However, we cannot guarantee that you or your family members will not contract COVID-19.
By participating in programs, services, and activities at our facility, you agree to the following:
I hereby release, covenant not to sue, discharge, and hold harmless Camp, its employees, agents, and representatives, of and
from all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating to your participation in our
programs, services, or activities. I understand and agree that this release includes any claims based on the actions, omissions,
or negligence of Camp, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or
after participation in any camp-hosted or programmed event.
Signature (for all 4 waivers): ___________________________________________________ Date:________________________
(Parent/Guardian signature if camper is a minor.)
Mile High | 909-794-2824 | www.milehighministries.org | 42739 State Hwy 38, Angelus Oaks, CA 92305
Alpine ǀ 909-337-3800 ǀ 415 Club House Dr., Blue Jay, CA 92317 I opt out of promotional/marketing outreach.
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Participant’s Name: ______________________________________________________________________ Group Name: ___________________________________
EMERGENCY CONTACT INFO:
Name: ____________________________________________________ DOB (MM/DD/YYYY): ______________________________
Gender: ☐ Male ☐ Female
Group: ____________________________________________________ Camp Dates: _______________________________________
Primary Emergency Contact: Mr. Mrs. Ms. Dr. (required): ______________________________________________________________
Relationship to Camper: ___________________________________ Day Phone: ________________________________________
Email: _____________________________________________________ Evening Phone: _____________________________________
(if different)
Address: ____________________________________________________________________________________________________________
Secondary Emergency Contact: Mr. Mrs. Ms. Dr.: _____________________________________________________________________
Relationship to Camper: ___________________________________ Day Phone: ________________________________________
Email: _____________________________________________________ Evening Phone: _____________________________________
(if different)
Address: ____________________________________________________________________________________________________________
(if different)
HEALTH HISTORY:
☐ I decline to provide health information to Camp.
1. Do you have any physical limitations, conditions, or difficulties that require consideration by Camp? If so, please describe
them & give instructions for accommodation (e.g. diabetes, epilepsy, mobility concerns): __________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
2. Are you bringing personal medication to camp? (If so, please store it in an area that is out of reach of others.)
☐ Yes ☐ No
ALLERGIES: If you have a severe allergy that causes anaphylactic shock, please bring Epinephrine kits to camp. If your
doctor’s orders are to use Benadryl in conjunction with an Epi-Pen, bring both to camp. We recommend that you report
conditions that require such interventions to your Group Nurse.
3. Date of last Tetanus booster: _________________________________ (Should be within the last 10yrs, or as advised by your physician.)
4. Date of last Physical: _________________________________________
DIETARY: ALL dietary restrictions/considerations must be reported to your Group Leader and to Camp prior to arrival.
Camp cannot avoid all allergens, but strives to keep a nut-free main menu; some of our products are manufactured in
facilities that also process meat, egg, nuts, soy, dairy, and gluten products. If you cannot consume these foods, you will
need to bring your own food substitutions.
If you are a vegan, a vegetarian who does not eat soy, cannot eat egg, cannot have dairy in baked goods, OR a
combination of these and other dietary considerations, you will need to bring your own food substitutions.
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Participant’s Name: ______________________________________________________________________ Group Name: ___________________________________
ACKNOWLEDGEMENT & RELEASE OF LIABILITY:
I understand that:
A. If I am dismissed from camp for any reason (e.g. illness, injury, rule/policy breaches), no amount of the fees paid to
Camp shall be refunded.
B. If I am dismissed from Camp for any reason, I will vacate the premises immediately, regardless of time of day,
condition, or convenience.
C. I cannot attend camp if my primary residence currently has a pest infestation (e.g. lice, bedbugs).
D. I cannot attend camp if I am recovering from a contagious condition/illness, or if I have been exposed to an
individual exhibiting symptoms of COVID-19 within the last five (5) days.
E. If I become ill, contract, or suffer from conditions/symptoms resulting from another individual unknowingly or
knowingly bringing pests, infections or disease to camp, Camp is not liable.
I consent and agree to attend Camp, abide by the policies, procedures, and traditions of Camp, and to participate in the
activities involved. I give my permission for Camp to assist my Group Leaders and Group Nurse in obtaining qualified
medical/surgical assistance and/or to administer aid, in the event of a personal accident or my illness.
Signature: _____________________________________________________________________ Date:________________________
(Parent/Guardian signature if camper is a minor.)
