If participant is under eighteen (18) years of age, the 

undersigned parent/guardian, hereby authorizes his/her son or 

daughter, to attend the 2019 Breakaway Retreat at Blue Mountain Christian Retreat and Clue Mountain Ski Resort on February 15-18. 

In the event of an emergency, said parent or guardian understands that all will be done to contact him/her. However, if the parent/guardian cannot be reached, permission is granted to the physician selected by the youth leader to hospitalize and/or secure proper treatment for, and to order such injections, anesthesia, or surgery as may be deemed necessary for the child’s welfare and protection.

The undersigned parent/guardian further acknowledges that his/her son or daughter may be photographed or captured on video as a participant on the 2019 Breakaway Retreat, and grant full permission to participating churches of the retreat to use photographs or videos in print, electronic, or public form. 

The undersigned participant, and participant’s guardian if participant is under eighteen (18) years of age on the date hereinafter indicated, does hereby release and discharge Westminster Presbyterian Church, its agents, youth leaders, employees, volunteers, and representatives, from any and all liability in connection with any activities carried on during its 2019 Breakaway Retreat, February 15-18,  including but not limited to claims of negligence, recklessness and any and all other claims alleging a failure to use reasonable care, including but not limited to claims made in connection with the use of transportation vehicles, facilities, buildings, land, fixtures, rock climbing, basketball, challenge course elements, ice and snow sports, work activities, and various field games and any other activities of any nature whatsoever conducted during its 2019 Breakaway Retreat. The undersigned hereby 

acknowledge that they have assumed all risk, known or unknown, in connection with transportation to and from and participation in the 2019 Breakaway Retreat.