Special Event Form

Please read and fill out the bottom portion of this form (including date and activity) and have a parent or guardian sign it for each individual "off-site" event that you attend. A medical release form must also be filled out once a school year and will be kept on file.

Authorization for Medical Treatment and Release

If my child, or I as an adult participant, become(s) injured or ill during an activity at The Gathering at Windsor or any activity which includes traveling with a 'Gathering' group, to and from an activity, I hereby authorize The Gathering at Windsor and/or a representative of The Gathering at Windsor to secure, at my expense, medical treatment including surgery, for my child or myself if I should be unconscious. I hereby authorize all health care providers to release all medical information regarding my child or me, if I am an adult participant, to my personal or group insurance company and to The Gathering at Windsor.

Furthermore, I understand that there is always risk with any activity and I will accept personal financial responsibility for any injury sustained during the activity. Further, I promise to indemnify, defend, and hold harmless the activity sponsor or its agents, employees, volunteers, or any other representatives (collectively referred to as the "Sponsor") for any injury related directly or indirectly to the described activity.

I give permission for my child/myself to participate in the event listed here (write in date and event):

Lake day ADDENDUM:

Parents/guardians--please circle a response and initial by each activity regarding water activities.

I give permission for my child to be in a power boat. Y N Initial:

I give permission for my child to ride on waterskis, tubes, bananas or other like equipment that is being towed by a power boat. Y N Initial:

I give permission for my child to swim in a lake where there is no certified lifeguard (watchful adults with former certification will be there). Y N Initial:

I give permission for my child to ride (not drive but ride only) on a jet ski.  Y  N  Initial:

Participant name:

Date:

Parent/Legal Guardian/Adult Participant:
(Print Name)

Parent/Legal Guardian/Adult Participant:
(Signature)

Please list emergency contact number:

Contact Pat Lundberg at 970.217.5026 if you need to get a hold of your student while attending an event. Thank you.