Camper Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent/Guardian Name *

First Name

Last Name

Phone *

(###)

###

####

Emergency Contact Name *

First Name

Last Name

Emergency Contact Phone *

(###)

###

####

By submitting this application, I am claiming to have understood the terms of this agreement. *

By allowing the listed child/student (“participant”) to participate in events, activities off and on site and transportation to and from events activities, I acknowledge and understand: There are certain inherent risks and dangers the child may encounter while traveling to, participating in, or returning from events, that could result in injury (whether physical, mental, social, economic, or emotional), death or some type of property loss. There may not be any or sufficient insurance provided by LifeBUILDERS for any type of injury, property loss or other damages that may occur and I have signed this document without any regard to whether LifeBUILDERS has insurance or maintains sufficient insurance for any type of claim, damage or loss. I agree to assume any and all risks and hazards of injury or loss arising out of or in the course of any event without regard to whether the risk or danger was reasonable and/or foreseeable by LifeBUILDERS. On behalf of any assignees, and myself, I release and hold LifeBUILDERS harmless from any and all liability and expense, including litigation costs and attorney fees arising out of any and all claims that I may have or later assert. In addition, I hereby waive all claims I may have against LifeBUILDERS, or any of its trustees, officers, employees, representatives, agents, and volunteers (LifeBUILDERS affiliates). I shall hold harmless and indemnity LifeBUILDERS and LifeBUILDERS affiliates from any and all claims, liabilities and expenses arising out of claims brought by third parties in connection with any acts or omission of the Participant. The laws of the State of Michigan shall govern this Agreement. I understand and acknowledge I have the option of not applying to allow the child to participate in events, and of not becoming involved in events if the terms and conditions listed above are not acceptable. I grant LifeBUILDERS all right, title, and interest in any and all photographic images and video or audio recordings made by LifeBUILDERS during my time spent with their organization, including, but not limited to, any royalties, proceeds, or other benefits derived from such photographs or recordings. LifeBUILDERS reserves the right to use any photograph/video taken at any event or activity sponsored by LifeBUILDERS, without the expressed written permission of those included within the photograph/video. LifeBUILDERS may use the photograph/video in publications or other media material produced, used or contracted by LifeBUILDERS including but not limited to brochures, invitations, books, newspapers, magazines, television and websites. LifeBUILDERS has put in place numerous preventative measures and enhanced cleaning protocols to reduce the likelihood of spreading COVID-19 at LifeBUILDERS. However, LifeBUILDERS cannot guarantee that you or your child will not become infected with COVID-19. Further, attending a LifeBUILDERS summer program could increase your child’s risk of contracting COVID-19. By signing the agreement, I acknowledge the contagious nature of COVID-19 and voluntarily agree to the participation terms. I assume the risk that my child, myself, and other family members may be exposed to or infected by COVID-19 by attending any camps and activities at LifeBUILDERS, and that such exposure or infection may result in personal injury, illness, permanent disability or death. I understand that the risk of becoming exposed to or infected by COVID-19 at LifeBUILDERS may result from actions, omissions, or negligence of myself, my child and others, including, but not limited to, LifeBUILDERS employees, volunteers, other campers and their families. I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injuries to my child, myself, and other family members (including, but not limited to, personal injury, disability or death), illnesses, damages, losses, claims, liability, costs or expenses, of any kind (collectively, “Claims”), that I, my child and our family may experience or incur in connection with my child’s attendance at LifeBUILDERS summer camps and programs. On my behalf, and on behalf of my child, I hereby release, covenant not to sue, discharge, and hold harmless LifeBUILDERS, its employees, volunteers, agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions or negligence of LifeBUILDERS, its employees, volunteers, agents, and representatives, whether a COVID-19 infection occurs before, during or after participation in a LifeBUILDERS summer camp program.

I agree