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  • Lonesome Dove Cowboy Church
  • Lonesome Dove Cowboy Church

Camp Summit Registration 2025

Lonesome Dove / Southern Cross Cowboy Church


Camper Information

Please submit one form per camper

Date of birth
Month
Day
Year
Gender
Female
Male
Shirt Size

Emergency Contact and Child's Medical Information

Alternative Emergency Contact

Medical Information

Photo Release Form

Accident Waver and Release of Liability Form

I HEREBY ASSUME ALL OF THE RISKS OF PARTICIPATING IN ANY/ALL ACTIVITIES ASSOCIATED WITH THIS EVENT, including by way of example and not limitation, any risks that may arise from negligence or carelessness in the part of the persons or entities being released, from dangerous or defective equipment or property owned, maintained, or controlled by them, or because of the possible liability without fault.

I certify that I am physically fit, have sufficiently prepared or trained for participation in this activity, and have not been advised to not participate by a qualified medical professional. I certify that there are no health-related reasons or problems which preclude my participation in this activity.

I acknowledge that this Accident Wavier and Release of Liability Form will be used by the event holders, sponsors, and organizers of the activity in which I may participate, and that it will govern my actions and responsibilities at said activity.

In consideration of my application and permitting me to participate in this activity, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors, and assigns as follows:

  • (A) I WAIVE, RELEASE, AND DISCHARGE from any and all liability, including but not limited to, liability arising from the negligence or fault of the entities or persons released, for my death, disability, personal injury, property damage, property theft, or actions of any kind which may hereafter occur to me including my traveling to and from this activity, THE FOLLOWING ENTITIES OR PERSONS: Lonesome Dove Cowboy Church, 4-C Ranch, or any Livestock Contractor and/or their directors, officers, employees, volunteers, representatives, and agents, and the activity holders, sponsors, and volunteers;

  • (B) INDEMNIFY, HOLD HARMLESS AND PROMISE NOT TO SUE the entities or persons mentioned in this paragraph from any and all liabilities or claims made as a result of participation in this activity, whether caused by the negligence of release otherwise.

I acknowledge that Lonesome Dove Cowboy Church and their directors, officers, volunteers, representatives, and agents. are NOT responsible for the errors, omissions, acts, or failures to act of any party or entity conducting a specific activity on their behalf.

I acknowledge that this activity may involve a test of a person's physical and mental limits and carries with it the potential for death, serious injury, and property loss. The risks include, but are not limited to, those caused by terrain, facilities, temperature, weather, condition of participants, equipment, vehicular traffic, lack of hydration, and actions of other people including, but not limited to, participants, volunteers, monitors, and/or producers of the activity. The risks are not only inherent to participants but are also present for volunteers.

I hereby consent to receive medical treatment which may be deemed advisable in the event of injury, accident, and/or illness during this activity.

I understand while participating in this activity, I may be photographed. I agree to allow my photo, video, or film likeness to be used for any legitimate purpose by the activity holders, producers, sponsors, organizers, and assigns.

The Accident Waiver and Release of Liability Form shall be constructed broadly to provide release and waiver to the maximum extent permissible under applicable law.


I CERTIFY THAT I HAVE READ THIS DOCUMENT AND I FULLY UNDERSTAND ITS CONTENT. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT AND I SIGN IT OF MY OWN FREE WILL.

Parent/Guardian Signature

(If under 18 years old, Parent or Guardian must also sign)

Date
Month
Day
Year

By submitting this form, you acknowledge that you are electronically signing this document and agree that your electronic signature is legally binding and equivalent to a handwritten signature.

Copyright © 2021 by Lonesome Dove Cowboy Church

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