Leadership Development Week Signup

(Street Name, City, State, Zip)
I hereby authorize medical treatment by a licensed hospital at the discretion of Brian or Diane Wheeler for the above-named youth/adult at this trip sponsored by the Westminster Woods Camp & Retreat Center, Inc. I also hereby authorize the making of photographs, motion pictures, videotapes, recording or other memorializing of said event and for my participation therein, and the publication of other use thereof, I waive any right to compensation therefore or any right that I otherwise might have to limit or control such making or use. I agree to cooperate and conform to directions and instructions of personnel responsible for activities. I will indemnify and hold harmless Westminster Woods Camp & Retreat Center, Inc. and its officers, agents, servants, or employees from any and all claims or causes of action by myself or by any other person or entity, and under no circumstances will present any claims against said organization and said persons for personal injury, property damage, wrongful death caused by an act of negligence by the camp Recourse for the payment of any hospital, medical, dental, or related cost and expenses will be paid either by me or my accident, hospital, or medical insurance, or any available benefit plan of mine.