AUTHORIZATION FOR HEALTH CARE
The following legal text is written in English for legal purposes. By signing this form I
understand that it is my responsibility to make arrangements for myself/attendee for all health
care needs. I authorize Forest Home, Inc. to arrange for or provide any necessary related
transportation to the nearest medical facility for urgent or emergency medical treatment if
indicated, and I do assume all responsibility for payment for such treatment. I hereby give
permission to the physician selected by Forest Home, Inc. to secure and administer any and
all medical treatment deemed necessary for myself/my attendee, including hospitalization.
This completed form may be photocopied for trips away from Forest Home, Inc. properties.
ACKNOWLEDGMENT AND ASSUMPTION OF RISKS INVOLVED
I have personally inspected Forest Home or, waived my right to do so and realize the risks
involved in participation in camp activities. I realize that Forest Home is not generally advised
for use by those with special needs, the disabled or those with needs related to walking on
their own such as with crutches or wheelchair, that there are risks and dangers involved in
such activities and that unanticipated and unexpected dangers may arise during such
activities.
I have requested Forest Home, Inc. to allow myself/my attendee to participate in any and all
activities that may include but are not limited to those outlined in the camp promotional
materials and/or media. As a condition of receiving this benefit, I do hereby agree to the
following: I understand that myself/my attendee's participation in these activities can expose
myself/him/her to dangers both from known and unanticipated risks.
I am willing to assume said risk of injury and/or complication of existing medical conditions to
my person, my property, (or those of my attendee) that may be sustained on the occasion of
the camp experience I (or my attendee) shall attend. I am aware that Advanced Life Support
teams, should they be needed, are up to twenty minutes away from Forest Home property.
RELEASE OF RESPONSIBILITY
Acknowledging that such risks exist, I on behalf of myself/my attendee and any other party
who may have the right to assert any rights for or on behalf of myself/my attendee, do hereby
forever release and discharge, indemnify and hold harmless Forest Home Inc., its affiliates,
officers, directors, agents, employees, insurers, successors in interest, attorneys, or any other
person or persons associated with any or all of them who might be liable (the "Released
Parties") from and against any and all claims, causes of action, actions, suits, demands,
losses, damages, expenses, costs or liability (collectively, "Losses") arising from or in
connection with myself/my attendee's participation in Forest Home, Inc.'s camp and its
activities, including Losses arising from the negligence of any of the Released Parties,
whether such Losses arise in connection with bodily injury (including death), property damage
or otherwise (collectively, the "Released Claims" The Released Claims include Losses arising
out of any condition of the premises at which the camp activities are held or the conduct of
any person in connection with the preparation for, supervision of, or conduct of any activity,
whether planned or unplanned. In the event that child abuse is reported while your attendee
is at Forest Home, we may fully cooperate with Child Protective Services and Law
Enforcement for the best interest of the child.
I represent and acknowledge that I have read and understand this form and the release
granted above and warrant that all statements made herein are true to the best of my
knowledge. I have read and understand this entire form and, by completing this form
electronically and by signing electronically below, I accept the terms herein and grant
permission for this record to be retained for as long as Forest Home deems necessary.