Forms Packet

2017

Please complete the below forms and e-mail them back to hockeycamps@liberty.edu

Confidential Health Report

Please e-mail this form to hockeycamps@liberty.edu

This report, containing parent and doctor's (if applicable) signatures must be completed before attending the Liberty University Christian Hockey School. We cannot accept a student's registration if he/she is not able to participate in the full program. The course includes a schedule of very rigorous athletic activities. If, following the completion of this medical form, an injury or illness is incurred which will prevent full participation in the program, the student must contact Liberty University Christian Hockey School immediately. The Director cannot accept a registration if the student arrives medically unfit to participate in full program activities.

PLEASE PRINT - FORM CAN BE COMPLETED BY PARENT/GUARDIAN (In consultation with student's doctor or health records). Student's Name: _______________________________________________________________________ Student’s Address: _________________________________ City: _______________________________ State: _________ Zip: ____________________ Phone #: ______________________________________ Weight: ___________ Height: ______________ Date of Birth: __________________________________ Insurance Information Please attach a copy of your insurance card (front & back) and return with this form.

Is the camper covered by family medical/hospital insurance? Yes or No

Family Health Insurance Provider: ______________________________________________________ Policy #: _______________________________ Insurance Plan: ______________________________ Group #: __________________________________ Policy Holder’s Name: ___________________

Home Address _______________ Relationship to Student: _______________________________________________________________ TO BE COMPLETED BY THE FAMILY DOCTOR OR PARENT/GUARDIAN

Office Use Only

Last Name: __________________

Camp Week: _________________

1. It has been recommended that a tetanus booster should be administered at the time of the physical examination if the student's booster record is not up to date. Date of Injection: ___________________ Any Previous Reaction: _____________________ 2. Has this student ever suffered any of the following: Please enter a YES or NO

• Appendicitis: ______ • Asthma: ______ • Epilepsy: ______ • Heart Disorder: ______ • Sinus: ______ • Non-Food Allergies (please specify) __________________________________________________

______________________________________________________________________________________________________________________________________________________________

3. Has this student ever suffered from the loss of a paired organ: Yes or No If Yes, please specify: _________________________________________________________________ 4. Has this student ever experienced serious muscle/bone difficulties?

• Ankles: ____________ • Knees: ____________ • Other: _____________

5. Has any member of this student’s family ever suffered a sudden death? Yes or No If yes, please specify: ________________________________________________________________ Allergies It is important that we are aware of your child/children’s food allergies. Please list all food/drink related allergies and diet instructions in the space below. Medication Information

1. Will camper be taking medications while at camp? Yes or No (Medications include prescription, over‐ the‐ counter, vitamins, inhalers, etc.)

2. Please list the medication name, the dosage amount, and the time that the medicine should be administered for each medication your child/children need.

1. Medication_____________ Dosage_________________ Take at what times _______________ Reason for Taking: _____________________________________________________________

2. Medication_____________ Dosage_________________ Take at what times _______________ Reason for Taking: _____________________________________________________________

3. Medication_____________ Dosage_________________ Take at what times _______________ Reason for Taking: _____________________________________________________________

4. Medication_____________ Dosage_________________ Take at what times _______________ Reason for Taking: _____________________________________________________________

If needed please attach a separate piece of paper with further instructions/information regarding your child’s medications. W (( ‐ , .( ( , ( .. ( , , , (, , , . , , ( ,),( ( ( , , , , ,)

( , , ( ( ) ( ( , , ( ( )( ( ) , , ,

Notes:

I believe, to the best of my knowledge, the above-named student to be in good health, (suffering from no illness and able to participate in all types of athletic activity, which demands physical exertion and stamina), and has not been exposed to any infectious disease. It is understood that, except for first-aid treatment, Liberty University Christian Hockey School will accept no responsibility or liability for accident or illness incurred by the student during the Program. I hereby give my approval for emergency medical treatment, if required. I also agree to have in place, complete and current health insurance coverage for the above named student during the registered program week(s). Signature of Parent or Guardian____________________________________ Date: __________________

2017 Camper Drop Off & Pick Up Form

Please list the names and phone numbers of people approved to drop off and pick up your child/children from Liberty University Christian Hockey

School throughout their designated camp week.

First and Last Name Phone Number

Camper Name: _______________________________________________ Parent/Guardian Signature: ____________________________________

Date: __________________ Parent Phone #: _______________________

Note

As you keep scrolling through this packet you will find the 3 following Assumption of Risk Forms.

• Ages 6-Under

• Ages 7-17

• Age 18

Please complete the appropriate assumption of risk form based

on your campers age (do not sign all 3 forms).

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Last Name: _________________

Week of Camp: _____________

s

ASSUMPTION OF RISK AGREEMENT

(For Participants Age 6 and Younger)

Please email this completed and signed Agreement to hockeycamps@liberty.edu

I desire to allow my child, who is a minor age 6 or younger (“Child”) to participate in the Liberty University Christian Hockey School, an ice hockey camp run by Liberty University’s American Collegiate Hockey Association coaches (“LUCHS”). In order for my Child to participate in the ultra-hazardous activity of playing ice hockey and all other activities available to my Child through participation in LUCHS at Liberty University’s campus (the “Activities”), I hereby agree to the terms below.

Medical Fitness and Treatment Authorization

I agree that my Child is in sufficiently good health to participate in the Activities and is free from any medical condition, physical or mental, which could interfere with my Child’s ability to participate in the Activities or which could be worsened by participating in the Activities or which could endanger my Child’s health or safety or the health or safety of other participants. In the event of an injury, illness, and/or accident involving my Child, I authorize Liberty University and/or its staff to seek medical attention or care on my Child’s behalf or to transport or cause my Child to be transported to a medical facility or hospital. I agree that Liberty University has no obligation to seek or provide such medical care to my Child. In the event Liberty University seeks transportation and/or medical care on my Child’s behalf, I agree to pay all charges related to such transportation and/or medical care, and to indemnify and hold harmless Liberty University from all such charges. Accident Investigation

I agree to instruct my Child that, in the event my Child witnesses or is involved in an accident or event resulting in property damage or personal injury of any kind, no matter how insignificant it may seem, my Child must immediately report such accident or event to a Liberty University employee or LUCHS staff member and to cooperate in the investigation of the accident or event.

Personal Equipment In the event that I or my Child brings any equipment or personal property to Liberty University’s campus, I agree to assume all risks associated with my or my Child’s use of such equipment or personal property. I agree that Liberty University is not responsible for any loss or theft of, or damage to, any equipment or personal property that I or my Child brings onto campus.

Behavior at Liberty University’s Campus I agree to instruct my Child to read and abide by all posted signs at Liberty University’s campus, including, but not limited to, posted signs at LaHaye Ice Center, LaHaye Recreational Center, Snoxflex, and all other Liberty University facilities, and to comply with all instructions from LUCHS staff and Liberty University employees. I agree to instruct my Child to not engage in any negligent or reckless behavior, as determined by LUCHS staff and Liberty University employees, while at Liberty University’s campus. Persons under the influence of drugs or alcohol are not permitted on campus. I agree to instruct my Child that, if my Child should have any questions about rules or whether certain behavior is permissible, my Child should ask an LUCHS staff member or Liberty University employee before engaging in the questionable behavior. I further agree that my Child’s failure to comply with such posted signs and instructions may result in my Child’s immediate removal from the Activities and/or Liberty’s campus without refund.

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Photography Consent

By signing this Agreement, I grant Liberty University my express written consent to use any photograph/likeness or video of my Child taken during the Liberty University Christian Hockey School for marketing and other related purposes, without any compensation required of Liberty University.

Duration and Binding Effect of Promises

I agree the representations, acknowledgements, and agreements that I make in this agreement are binding upon me, as well as upon my assignees, subrogors, distributees, family members, heirs, next-of-kin, executors, personal representatives, administrators and successors of every kind, forever, which includes any time I or my Child enters onto Liberty University’s campus or participates in the Activities at Liberty University’s campus in the future.

Governing Law; Forum Selection

This agreement will be governed by Virginia law. Any claim or action arising out of this agreement must be brought in a court located in Lynchburg, Virginia. Severability

I expressly agree that this Agreement is intended to be as broad and inclusive as permitted by Virginia law, and that if any portion of this Agreement is invalid, I agree that the remaining portion of this Agreement will remain in full force and effect.

PARENT/GUARDIAN CONSENT

As the parent and/or legal guardian of the participant Child identified above, I agree I have carefully read and understand this agreement, I agree to all terms above and adopt all of the representations, acknowledgements, consents, and agreements herein and hereby assume the risk that the participant Child may be injured or even killed while participating in the Activities, and I consent to the participant Child’s participation in the Activities.

Signature of Parent/Legal Guardian: Date:

Name of Parent/Legal Guardian (Print):

Name of Participant: Age: Date of Birth:

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Last Name: _________________

Week of Camp: _____________

s

ASSUMPTION OF RISK AGREEMENT

(For Participants Ages 7 – 17)

Please email this completed and signed Agreement to hockeycamps@liberty.edu

I desire to participate in the Liberty University Christian Hockey School, an ice hockey camp run by Liberty University’s American Collegiate Hockey Association coaches (“LUCHS”). In consideration of my being allowed to participate in the ultra-hazardous activity of playing ice hockey and all other activities available to me through my participation in LUCHS at Liberty University’s campus (the “Activities”), I understand that I am assuming all risks and dangers associated with the Activities, including, but not limited to, those risks and dangers specifically identified in the following provisions: General Risks The Activities involve physical activity, which is hazardous. The Activities have certain risks and dangers, some of which cannot be eliminated regardless of the care taken to avoid these risks. I voluntarily agree that I understand that, by participating in the Activities, I am putting myself at risk of damage or loss of my property, temporary or permanent injury to my body, sickness, and even death. Specific risks and dangers that may be involved in the Activities include, but are not limited to: physical contact with other participants and their playing equipment (including things like hockey sticks, pads, helmets, rackets, ice skates, etc.); contact with fast-moving playing equipment (including things like pucks, hockey sticks, balls, etc.); variations in the playing surface; contact with the playing surface and the surrounding things; collisions with other participants or spectators; contact with goals, nets, walls, and maintenance equipment; equipment failure or misuse; environmental conditions (including weather); and slipping, tripping, falling, and my individual tendency to get hurt (whether I know of this tendency or not). The results of these and other risks may include, but are not limited to, serious neck and spinal injuries; causing complete or partial paralysis and/or brain damage; serious injury to all internal organs; serious injury to all bones, joints, ligaments, muscles, tendons, and other aspects of the musculoskeletal system; concussions; dehydration; heat stroke; fatigue; fainting; dizziness; sprains; loss of sight; loss of hearing; skin lacerations, punctures, and disfigurement; cardiovascular risks, including heart attacks; and other serious injury to or impairment of other parts of the body, general health, and well-being. I understand that the dangers and risks of participation in the Activities may impair my future ability to earn a living; to participate in business, social, and recreational activities; and to generally enjoy life. I agree that I have valid and current insurance to cover any injury or damage I may cause or suffer while participating in the Activities or I (or my parent/legal guardian) agree(s) to personally bear the costs of such injury or damage. Risks for Activities on Ice Surfaces Activities taking place on ice surfaces have certain risks, some of which cannot be eliminated regardless of the care taken to avoid these risks. Including the risks identified above, specific risks that may arise while participating in Activities on ice surfaces include, but are not limited to: variations in ice and surface conditions; difficulty walking and/or skating in ice skates (on and off the ice); loss of control while on the ice; collisions with other participants or spectators; contact with surfaces, walls, and maintenance equipment; and contact with ice skate blades causing lacerations or punctures to the body. Risks for Activities In and Around Swimming Pools Activities taking place in and around swimming pools have certain risks, some of which cannot be eliminated regardless of the care taken to avoid these risks. Including the risks identified above, specific risks that may arise while participating in Activities taking place in and around swimming pools include, but are not limited to: physical contact with other swimmers and equipment; equipment failure; drowning; water intake through various body openings; dangerous water, pool deck, or diving board/platform conditions; sudden contact with the pool deck, subsurface, or diving boards/platforms; and flotation device malfunction. Understanding the risks involved with

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participating in these Activities, I represent that I can swim well. I understand that my participation in the Activities taking place in and around swimming pools may not be supervised and that lifeguards or other persons trained in life saving techniques may not be available if I need assistance. Risks for Activities at Liberty Mountain Snowflex® Centre (“Snowflex”) WARNING: Under Virginia law, a ski area operator or other winter sports area operator is not liable for an injury to or death of a winter sports participant in a winter sport conducted at this location, or for damage to property, if such injury, death, or damage results from the inherent risks of the winter sport or from the participant's own negligence. The inherent risks of a winter sport include, among others, risks associated with the land, equipment, other participants, and animals, as well as the potential for you or another participant to act in a negligent manner that may contribute to the injury, death, or damage. You are assuming the inherent risks of participating in a winter sport at this location. Complete copies of the applicable Virginia law and the participant responsibility code published by the National Ski Areas Association are available for review at each ticket sales office of this winter sports area and online at http://www.liberty.edu/snowflex/. Virginia Code 8.01-227.12. ACTIVITIES AT SNOWFLEX ARE DANGEROUS AND PUT ME AT RISK OF INJURY OR EVEN DEATH. INJURIES ARE A COMMON AND ORDINARY OCCURRENCE TO THOSE WHO PARTICIPATE IN ACTIVITIES PROVIDED WITHIN SNOWFLEX. These dangerous Activities include, but are not limited to, skiing, snowboarding, tubing, racing, instruction, trampoline jumping, jumping or falling onto a stunt airbag, skiing/snowboarding competitions at Snowflex and on man-made snow/ice on Liberty University’s campus, and all other Activities that may occur within Snowflex or at those on-campus locations. These risks include, but are not limited to, variations in terrain, physical exertion, the design of Snowflex and related structures, the design and installation of and variable conditions in the artificial snow medium, snow, and Neveplast tube runs, patches of ice, slipping, tripping, falling (including, for overnight camps, falling out of bunk beds), difficulty walking in ski or snowboarding boots, classification of trails, loss of control, equipment failure, negligence of other participants, environmental conditions (including weather), and collisions with: (i) other participants or their equipment (whether moving or stationary), (ii) spectators (whether moving or stationary), (iii) trees, (iv) rocks, (v) buildings, (vi) equipment, (vii) terrain features (whether natural or manmade), (viii) light poles, and (ix) ski lifts, tramways and related apparatuses. I may also suffer injury in the event I leave the area covered by the artificial snow medium and travel or fall onto the surrounding gravel and terrain. I am not protected from all features or objects within Snowflex (whether natural or manmade) that could injure me as a result of a collision with or falls from these features or objects. Certain structures or features within Snowflex may be padded and some ramp landing zones might be covered with stunt airbags. My collision with any padded object or fall onto a stunt airbag may still result in my injury or death. I am also put at risk of failures in my ski, snowboard, tube, or other equipment, or failures of equipment belonging to or used by other participants in Snowflex. In addition to these known risks and dangers, there are unknown risks of serious physical injury or even my death from Activities in Snowflex. I understand that wearing a safety helmet is recommended when using Snowflex, and required when using any terrain park features. If Snowflex employees do not offer me one, I agree to ask for one. I understand that a helmet may or may not protect me from injury or death. However, if I refuse to wear a helmet, I agree that do so at my own risk. Due to the risk of suffering abrasion from bare skin contacting the artificial snow medium, I understand that it is highly recommended that I wear attire that covers my exposed skin, including a long sleeve shirt and pants, and if wear short sleeves or pants, I should wear elbow or knee pads. If I choose not to do so, I agree that I do so at my own risk.

Risks for Activities On and Around Climbing Walls Activities taking place on and around climbing walls have certain risks, some of which cannot be eliminated regardless of the care taken to avoid these risks. Including the risks identified above, specific risks that may arise while

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participating in Activities taking place on and around climbing walls include, but are not limited to: falling off or from the climbing wall and hitting the floor, wall faces, people, or any other equipment used in climbing, whether permanently or temporarily in place; rope abrasion and/or entanglement; injuries resulting from falling climbers, dropped items, or broken holds; failure of ropes, knots, belays, slings, harnesses, climbing holds, anchor points, helmets, or other equipment or part of the climbing wall; unwanted or accidental physical contact with other individuals or their equipment; and protective and safety equipment failure (e.g., helmet, harness, etc.).

Medical Fitness and Treatment Authorization I agree that I am in sufficiently good health to participate in the Activities and am free from any medical condition, physical or mental, which could interfere with my ability to participate in the Activities or which could be worsened by participating in the Activities or which could endanger my health or safety or the health or safety of other participants. In the event of an injury, illness, and/or accident involving me, I authorize Liberty University and/or its staff to seek medical attention or care on my behalf or to transport or cause me to be transported to a medical facility or hospital. I agree that Liberty University has no obligation to seek or provide such medical care to me. In the event Liberty University seeks transportation and/or medical care on my behalf, I (or my parent/legal guardian) agree(s) to pay all charges related to such transportation and/or medical care. I (or my parent/legal guardian) further agree(s) to indemnify and hold harmless Liberty University from all such charges. Accident Investigation In the event I witness or am involved in an accident or event resulting in property damage or personal injury of any kind, no matter how insignificant it may seem, I agree to immediately report such accident or event to a Liberty University employee or LUCHS staff member and to cooperate in the investigation of the accident or event. Personal Equipment In the event I bring any equipment or personal property to Liberty University’s campus, I agree to assume all risks associated with the use of such equipment or personal property. I agree Liberty University is not responsible for any loss or theft of, or damage to, any equipment or personal property I bring onto campus.

Behavior at Liberty University’s Campus I agree to read and abide by all posted signs at Liberty University’s campus, including, but not limited to, posted signs at LaHaye Ice Center, LaHaye Recreational Center, Snoxflex, and all other Liberty University facilities, and to comply with all instructions from LUCHS staff and Liberty University employees. I agree to not engage in any negligent or reckless behavior, as determined by LUCHS staff and Liberty University employees, while at Liberty University’s campus. Persons under the influence of drugs or alcohol are not permitted on campus. I agree that, if I have any questions about rules or whether certain behavior is permissible, I will ask an LUCHS staff member or Liberty University employee before engaging in the questionable behavior. I further agree that my failure to comply with this paragraph may result in my immediate removal from the Activities and/or Liberty’s campus without refund. Photography Consent By signing this Agreement, I grant Liberty University my express written consent to use any photograph/likeness or video of me (or my minor child) taken during the Liberty University Christian Hockey School for marketing and other related purposes, without any compensation required of Liberty University. Duration and Binding Effect of Promises I agree the representations, acknowledgements, and agreements that I make in this agreement are binding upon me, as well as upon my assignees, subrogors, distributees, family members, heirs, next-of-kin, executors, personal representatives, administrators and successors of every kind, forever, which includes any time I enter onto Liberty University’s campus or participate in the Activities at Liberty University’s campus in the future.

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Governing Law; Forum Selection This agreement will be governed by Virginia law. Any claim or action arising out of this agreement must be brought in a court located in Lynchburg, Virginia. Severability I agree that this Agreement is intended to be as broad and inclusive as permitted by Virginia law, and that if any portion of this Agreement is invalid, I agree that the remaining portion of this Agreement will remain in full force and effect.

PARTICIPANT CONSENT (required of all eligible participants, ages 7 – 17)

BY SIGNING BELOW, I AGREE I HAVE CAREFULLY READ AND UNDERSTAND THIS AGREEMENT, I AGREE TO ALL THE TERMS ABOVE, AND I HEREBY ASSUME THE RISKS AND DANGERS ASSOCIATED WITH THE ACTIVITIES BY MY VOLUNTARY PARTICIPATION AND BY MY SIGNATURE BELOW.

Signature of Participant: Date:

Name of Participant: Age: Date of Birth:

PARENT/GUARDIAN CONSENT (required if the participant is less than 18 years of age)

As the parent and/or legal guardian of the minor participant identified above, I agree I have carefully read and understand this agreement, I agree to all terms above and adopt all of the representations, acknowledgements, and agreements made by the minor participant, both personally and on behalf of the minor participant, and I hereby assume the risk that the minor participant may be injured or even killed while participating in the Activities and consent to the minor participant’s participation in the Activities.

Signature of Parent/Legal Guardian: Date:

Name of Parent/Legal Guardian (Print):

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Last Name: _________________

Week of Camp: _____________

s

ASSUMPTION OF RISK AGREEMENT

(For Participants Age 18 and Older)

Please email this completed and signed Agreement to hockeycamps@liberty.edu

I desire to participate in the Liberty University Christian Hockey School, an ice hockey camp run by Liberty University’s American Collegiate Hockey Association coaches (“LUCHS”). In consideration of my being allowed to participate in the ultra-hazardous activity of playing ice hockey and all other activities available to me through my participation in LUCHS at Liberty University’s campus (the “Activities”), I understand that I am assuming all risks and dangers associated with the Activities, including, but not limited to, those risks and dangers specifically identified in the following provisions: General Risks The Activities involve physical activity, which is hazardous. The Activities have certain inherent risks and dangers, some of which cannot be eliminated regardless of the care taken to avoid these risks. I voluntarily acknowledge that, by participating in the Activities, I am exposing myself to the risk of property damage, temporary or permanent (potentially serious) bodily injury, and even death. Specific risks and dangers that may be involved in the Activities include, but are not limited to: physical contact with other participants and their playing equipment (including things like hockey sticks, pads, helmets, rackets, ice skates, etc.); contact with fast-moving playing equipment (including things like pucks, hockey sticks, balls, etc.); variations in the playing surface; contact with the playing surface and surrounding elements; collisions with other participants or spectators; contact with goals, nets, walls, and maintenance equipment; equipment failure or misuse; environmental conditions (including weather); and slipping, tripping, falling, and my individual susceptibility to harm or injury (whether known or unknown to me). The results arising from these and other inherent risks may include, but are not limited to, serious neck and spinal injuries; causing complete or partial paralysis and/or brain damage; serious injury to all internal organs; serious injury to all bones, joints, ligaments, muscles, tendons, and other aspects of the musculoskeletal system; concussions; dehydration; heat stroke; fatigue; fainting; dizziness; sprains; loss of sight; loss of hearing; skin lacerations, punctures, and disfigurement; cardiovascular risks, including heart attacks; and other serious injury or impairment of other parts of the body, general health, and well-being. I understand that the dangers and risks of participation in the Activities may impair my future ability to earn a living; engage in business, social, and recreational activities; and to generally enjoy life. I assert that I have valid and current insurance to cover any injury or damage I may cause or suffer while participating in the Activities or I (or my parent/legal guardian) agree(s) to personally bear the costs of such injury or damage. Risks for Activities on Ice Surfaces Activities taking place on ice surfaces have inherent risks, some of which cannot be eliminated regardless of the care taken to avoid these risks. Including the risks identified above, specific risks that may arise while participating in Activities on ice surfaces include, but are not limited to: variations in ice and surface conditions; difficulty walking and/or skating in ice skates (on and off the ice); loss of control while on the ice; collisions with other participants or spectators; contact with surfaces, walls, and maintenance equipment; and contact with ice skate blades causing lacerations or punctures to the body. Risks for Activities In and Around Swimming Pools Activities taking place in and around swimming pools have inherent risks, some of which cannot be eliminated regardless of the care taken to avoid these risks. Including the risks identified above, specific risks that may arise while participating in Activities taking place in and around swimming pools include, but are not limited to: physical contact with other swimmers and equipment; equipment failure; drowning; water intake through various body openings; dangerous water, pool deck, or diving board/platform conditions; sudden contact with the pool deck,

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subsurface, or diving boards/platforms; and flotation device malfunction. Understanding the risks involved with participating in these Activities, I represent that I can swim well. I understand that my participation in the Activities taking place in and around swimming pools may not be supervised and that lifeguards or other persons trained in life saving techniques may not be available should I need assistance. Risks for Activities at Liberty Mountain Snowflex® Centre (“Snowflex”) WARNING: Under Virginia law, a ski area operator or other winter sports area operator is not liable for an injury to or death of a winter sports participant in a winter sport conducted at this location, or for damage to property, if such injury, death, or damage results from the inherent risks of the winter sport or from the participant's own negligence. The inherent risks of a winter sport include, among others, risks associated with the land, equipment, other participants, and animals, as well as the potential for you or another participant to act in a negligent manner that may contribute to the injury, death, or damage. You are assuming the inherent risks of participating in a winter sport at this location. Complete copies of the applicable Virginia law and the participant responsibility code published by the National Ski Areas Association are available for review at each ticket sales office of this winter sports area and online at http://www.liberty.edu/snowflex/. Virginia Code 8.01-227.12. ACTIVITIES AT SNOWFLEX ARE DANGEROUS AND EXPOSE ME TO RISKS OF INJURY OR EVEN DEATH. INJURIES ARE A COMMON AND ORDINARY OCCURRENCE TO THOSE WHO PARTICIPATE IN ACTIVITIES PROVIDED WITHIN SNOWFLEX. These dangerous Activities include, but are not limited to, skiing, snowboarding, tubing, racing, instruction, trampoline jumping, jumping or falling onto a stunt airbag, skiing/snowboarding competitions at Snowflex and on man-made snow/ice on Liberty University’s campus, and all other Activities that may occur within Snowflex or at those on-campus locations. These risks include, but are not limited to, variations in terrain, physical exertion, the design of Snowflex and related structures, the design and installation of and variable conditions in the artificial snow medium, snow, and Neveplast tube runs, patches of ice, slipping, tripping, falling (including, for overnight camps, falling out of bunk beds), difficulty walking in ski or snowboarding boots, classification of trails, loss of control, equipment failure, negligence of other participants, environmental conditions (including weather), and collisions with: (i) other participants or their equipment (whether moving or stationary), (ii) spectators (whether moving or stationary), (iii) trees, (iv) rocks, (v) buildings, (vi) equipment, (vii) terrain features (whether natural or manmade), (viii) light poles, and (ix) ski lifts, tramways and related apparatuses. I may also suffer injury in the event I leave the area covered by the artificial snow medium and travel or fall onto the surrounding gravel and terrain. I am not protected from all features or objects within Snowflex (whether natural or manmade) that could injure me as a result of a collision with or falls from these features or objects. Certain structures or features within Snowflex may be padded and some ramp landing zones might be covered with stunt airbags. My collision with any padded object or fall onto a stunt airbag may still result in my injury or death. I am also exposed to risks from failures in my ski, snowboard, tube, or other equipment, or failures of equipment belonging to or used by other participants in Snowflex. In addition to these known risks and dangers, there are unknown risks of serious physical injury or even my death from Activities in Snowflex. I understand that wearing a safety helmet is recommended when using Snowflex, and required when using any terrain park features. If Snowflex employees do not offer me one, I agree to ask for one. I understand that a helmet may or may not protect me from injury or death. However, if I refuse to wear a helmet, I agree that do so at my own risk. Due to the risk of suffering abrasion from bare skin contacting the artificial snow medium, I understand that it is highly recommended that I wear attire that covers my exposed skin, including a long sleeve shirt and pants, and if wear short sleeves or pants, I should wear elbow or knee pads. If I choose not to do so, I agree that I do so at my own risk.

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Risks for Activities On and Around Climbing Walls Activities taking place on and around climbing walls have inherent risks, some of which cannot be eliminated regardless of the care taken to avoid these risks. Including the risks identified above, specific risks that may arise while participating in Activities taking place on and around climbing walls include, but are not limited to: falling off or from the climbing wall and hitting the floor, wall faces, people, or any other equipment used in climbing, whether permanently or temporarily in place; rope abrasion and/or entanglement; injuries resulting from falling climbers, dropped items, or broken holds; failure of ropes, knots, belays, slings, harnesses, climbing holds, anchor points, helmets, or other equipment or part of the climbing wall; unwanted or accidental physical contact with other individuals or their equipment; and protective and safety equipment failure (e.g., helmet, harness, etc.).

Medical Fitness and Treatment Authorization I agree that I am in sufficiently good health to participate in the Activities and am free from any medical condition, physical or mental, which could interfere with my ability to participate in the Activities or which could be worsened by participating in the Activities or which could endanger my health or safety or the health or safety of other participants. In the event of an injury, illness, and/or accident involving me, I authorize Liberty University and/or its staff to seek medical attention or care on my behalf or to transport or cause me to be transported to a medical facility or hospital. I agree that Liberty University has no obligation to seek or provide such medical care to me. In the event Liberty University seeks transportation and/or medical care on my behalf, I (or my parent/legal guardian) agree(s) to pay all charges related to such transportation and/or medical care. I (or my parent/legal guardian) further agree(s) to indemnify and hold harmless Liberty University from all such charges. Accident Investigation In the event I witness or am involved in an accident or event resulting in property damage or personal injury of any kind, no matter how insignificant it may seem, I agree to immediately report such accident or event to a Liberty University employee or LUCHS staff member and to cooperate in the investigation of the accident or event. Personal Equipment In the event I bring any equipment or personal property to Liberty University’s campus, I agree to assume all risks associated with the use of such equipment or personal property. I agree Liberty University is not responsible for any loss or theft of, or damage to, any equipment or personal property I bring onto campus.

Behavior at Liberty University’s Campus I agree to read and abide by all posted signs at Liberty University’s campus, including, but not limited to, posted signs at LaHaye Ice Center, LaHaye Recreational Center, Snoxflex, and all other Liberty University facilities, and to comply with all instructions from LUCHS staff and Liberty University employees. I agree to not engage in any negligent or reckless behavior, as determined by LUCHS staff and Liberty University employees, while at Liberty University’s campus. Persons under the influence of drugs or alcohol are not permitted on campus. I agree that, if I have any questions about rules or whether certain behavior is permissible, I will ask an LUCHS staff member or Liberty University employee before engaging in the questionable behavior. I further agree that my failure to comply with this paragraph may result in my immediate removal from the Activities and/or Liberty’s campus without refund. Photography Consent By signing this Agreement, I grant Liberty University my express written consent to use any photograph/likeness or video of me (or my minor child) taken during the Liberty University Christian Hockey School for marketing and other related purposes, without any compensation required of Liberty University. Duration and Binding Effect of Promises I agree the representations, acknowledgements, and agreements that I make in this agreement are binding upon me, as well as upon my assignees, subrogors, distributees, family members, heirs, next-of-kin, executors, personal

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representatives, administrators and successors of every kind, forever, which includes any time I enter onto Liberty University’s campus or participate in the Activities at Liberty University’s campus in the future.

Governing Law; Forum Selection This agreement will be governed by Virginia law. Any claim or action arising out of this agreement must be brought in a court located in Lynchburg, Virginia. Severability I expressly agree that this Agreement is intended to be as broad and inclusive as permitted by Virginia law, and that if any portion of this Agreement is invalid, I agree that the remaining portion of this Agreement will remain in full force and effect.

PARTICIPANT CONSENT (required of all eligible participants age 18 and older)

BY SIGNING BELOW, I AGREE I HAVE CAREFULLY READ AND UNDERSTAND THIS AGREEMENT, I AGREE TO ALL THE TERMS ABOVE, AND I HEREBY VOLUNTARILY AND WILLFULLY ASSUME ALL OF THE RISKS AND DANGERS ASSOCIATED WITH THE ACTIVITIES.

Signature of Participant: Date:

Name of Participant: Age: Date of Birth:

Note

Please ensure that you have completely filled out each of the

below forms.

• Confidential Health Report

o Please include a copy of your insurance card (front/back)

• Camper Drop Off & Pick Up Form

• The Appropriate Assumption of Risk Form (based on age)

Once they are completed & signed, please e-mail them to

hockeycamps@liberty.edu with your campers first name, last

name, and week of camp in the subject line.

Thank you!