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Leaders Retreat Waiver

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Acknowledgment of Risk, Waiver of Liability,

and Consent for Treatment:

I, the undersigned parent or guardian do hereby grant permission for my son/daughter/ward


__________________________________________ to join the Every Nation Campus Tarlac Leaders
Retreat this August 25-26, 2023 at Balkonahe De San Jose, Brgy. David, San Jose, Tarlac.

In granting permission for my son/daughter to join the Every Nation Campus Tarlac Leaders Retreat, I
acknowledge and understand that as the facilitators of this event will exercise all precautionary measures and
the standard public health protocol. There are risks inherent in any physical gathering, including but not limited
to (both acute and permanent) injury, disability, physical illness, or death arising from: participation in physical
activities; participant’s failure to follow rules, instructions and guidelines of event facilitators; communicable
illness; and independent acts of third parties not under the control of event facilitators.

I acknowledge, understand and agree that not all risks can be prevented, and therefore I hereby assume any
and all risks beyond the control of Every Nation Campus, its event facilitators and staff. Further, I hereby fully
and forever waive, release, acquit, hold harmless, and discharge Every Nation Campus, its event facilitators
and staff, from any and all claims, demands, rights, losses, suits, actions and causes of action, obligations,
damages, costs, or expenses of any nature relating to injury, disability, physical illness of any type suffered
during or otherwise arising from Every Nation Campus Tarlac Leaders Retreat.
In order to minimize risks to my son/daughter/ward or other participants, I will take responsibility to see that my
son/daughter/ward is properly prepared for all activities and is in good health each day of the event. In case of
a medical emergency, I give my permission to the adults in charge of the Every Nation Campus Tarlac
Leaders Retreat to secure emergency medical treatment for my son/daughter/ward. I understand that every
reasonable attempt will be made to contact me, or the emergency contact named below. Furthermore, I
acknowledge, understand and agree that I am responsible for medical expenses that result from any injury or
disability arising out of the Every Nation Campus Tarlac Leaders Retreat.

Lastly, I certify that I am the parent or legal guardian of _____________________________________ and


acknowledge that the authorizations, agreements and waivers included herein apply to
____________________________________.
Parent/Guardian Name & Signature: ___________________________________________
Contact Number : _________________
*For my child’s comfort and safety, please consult below (allergies, medical condition, medical prescriptions,
recent injuries or illnesses, etc.) for any special conditions I feel you need to know about.
_________________________________________________________________________________.

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