Personal Information

Name:     __________________________________________________   Sex:  _____

Address:  ________________________________________________________________

          ________________________________________________________________

          ________________________________________________________________

Phone:    (      ) ________________________ (h)

Phone:    (      ) ________________________ (w)

School:   ___________________   Dept.:  __________________________________

Email:    ________________________________________________________________

Inter-Varsity Christian Fellowship of the United States of America

d/b/a Campus by the Sea

Individual Release

(Release must be signed by camper and parent or legal guardian)

I understand that Campus by the Sea, a camp operated by Inter-Varsity Christian Fellowship of the United States of America (Inter-Varsity), has rustic facilities, is located on a rugged mountainous island, and is accessible only by boat or by foot. I also understand that participation in any activities, recreational or otherwise, will carry risks inherent to such activities and to the wilderness location.

Of my free will, I desire to participate in activities which carry a special risk of injury or loss to person or property including, but not limited to: swimming in open water, sailing, water-skiing, snorkeling and skin diving, hiking, travel by public carrier, and/or organized games, and understand that such activities carry inherent risks.

In consideration for being permitted to engage in this activity, I agree to abide by expressed rules and requirements for the activity. For myself and any who would claim under me, I release and discharge Inter-Varsity, its trustees, employees, and agents from any liability resulting from loss, injury, or damage to my person or property as a result of my attendance at or participation in this activity,excluding any liability arising solely from the negligent actions of Inter-Varsity, its trustees, employees, or agents.

Camper's Name _____________________________________________

Camper's Signature __________________________________________

For campers under the the age of 18:

I consent to participation by _____________________________
                              (print name of camper)

in the above described activity(s) and fully agree with this release.

___________________________________________             _______________
   Signature of Parent or Legal Guardian                     Date