Cornerstone Chapel

Pine Creek - HS002


Welcome to Pine Creek Camp & Retreat Center’s Adventurous Activities! Including, but not limited to, Zip-Line, Rockwall, Inflatable and Paddle Boats. Activities may include reliance on others or equipment, climbing over obstacles and walking trails. We are confident you will find it a great experience, both fun and challenging!

When working outdoors and leading physical activities, safety is our main concern. We will regularly discuss basic rules of safety and provide the special organization, supervision, instruction and equipment you need to participate safely in the activities. It is impossible for us to eliminate all risk, however, your commitment to follow instructions and use sound personal judgment will contribute greatly to your well being. By signing this waiver, the participant and/or guardian accepts that there are inherent risks and hazards in these Adventurous Activities and agrees not to sue PINE CREEK CAMP & RETREAT CENTER.

Please read and sign the following agreement:

I, as a participant or parent/guardian of a participant, understand I will be participating in activities that involve periods of physical exertion, balancing, heights (up to 80’), climbing and pulling. I know most activities will be outdoors where I will need to watch for slippery and/or uneven footing, limbs and branches, insects or animals and possible exposure to extreme or inclement weather. I fully understand that my physical activity involves risk of injury. I understand the risks may include loss or damage to personal property.

I understand that I will not be forced to do any activity and that despite all reasonable precaution taken, a guarantee of absolute safety is impossible. I agree to exercise good personal judgment, to ask for help if I am concerned about my safety and to be responsible for deciding if a proposed activity is appropriate for me. I agree to inform my instructors of any physical, mental or medical condition that might affect my ability to participate or affect other members of my group. I realize that failure to tell that information could result in serious harm to myself or others. I also state that I am not under, and will not be under the influence of any chemical substance including alcohol.

I agree to comply with safety instructions given and to be responsible for my personal safety and well being. I/We agree not to hold PINE CREEK CAMP & RETREAT CENTER, its Directors, Officers, Employees, Agents and/or Associates responsible for any accidents, injury, loss of or damage to property that may occur while doing these activities.

I/We understand that all possible precautions are taken to insure that all activities offered by PINE CREEK CAMP & RETREAT CENTER are conducted by mature and qualified personnel in a safe and responsible manner. I voluntarily assume the risks of the activities and agree to report any injuries before leaving the premises.

In the event of an emergency, I/We understand every attempt will be made to contact the parent/guardian. In the event that the parent/guardian cannot be reached, I/We give permission to PINE CREEK CAMP & RETREAT CENTER, to secure proper medical treatment. I understand that I am responsible for all medical expenses incurred for any injuries while participating in the activities.

I/We have read and understand all materials outlining the activities, including this waiver and agree to abide by these terms. I am aware this is a waiver and a release of liability and I sign it voluntarily.

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Participant Signature (if under 18 parent/guardian of participant must sign)

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Signature Certificate
Document name: Pine Creek - HS002
lock iconUnique Document ID: eac46608d17f262b3abe04aa15b9c8f2e012fd7c
Timestamp Audit
November 30, 2019 11:20 am EDTPine Creek - HS002 Uploaded by Cornerstone Chapel - IP
November 30, 2019 1:57 pm EDTHigh School - added by Cornerstone Chapel - as a CC'd Recipient Ip:
February 20, 2020 4:50 pm EDTHigh School - added by Cornerstone Chapel - as a CC'd Recipient Ip:
October 27, 2021 10:08 pm EDTHigh School - added by Cornerstone Chapel - as a CC'd Recipient Ip: