THE DETAILS A nonrefundable deposit of $150 is due at registration.
Deposits are due & Registration closes March 31, 2019
(All payments are considered a contribution to the church
and therefore are non-refundable.)
All forms and final payments MUST be turned in by
June 1, 2019.
Please complete the following forms and register online:
2019 Grace Missions Covenant
2019 Grace Waiver
SIFAT Medical Release
Whitewater Express Waiver
SIFAT
SIFAT is a Christian organization
that exist to help people from
different countries, cultures and
social classes understand each
other and work together, so that
every person can have a chance
to develop into the person God
intends for each to be. The
SIFAT team desires to bring the
Kingdom of God closer to all.
https://sifat.org/
THE TRIP
This year we are combining
middle school and high school
to take over one of SIFAT’s Learn
& Serve Experience weeks. We
will learn how to think globally
and act locally, while learning
about poverty around the world
and simple solutions to world-
wide problems. We will also
have the opportunity to serve
the local community of Lineville.
All while enjoying the beautiful
SIFAT grounds.
COST : $464.50
includes transportation,
housing, most meals, t-shirt, and
a whitewater adventure.
LINEVILLE, AL June 22-29, 2019 // Grace Student Ministries // Mission Trip
THE TRIP AT A GLANCE
SIFAT’s 2019 theme is ‘Bloom’. We will discover how to walk with the Lord to bloom personally and within
our communities for His glory and our good. We will also
have the opportunity to spend time with SIFAT graduates
from Congo and Uganda to learn about the specific
needs in their regions and what God is doing through His
people to meet them.
We will spend the first two days of the week immersed in
the rural villages and foreign cities through a global
village and slum simulation experience. This means we
will be camping for two nights of the week.
During the second half of the week, we will join with SIFAT
graduates from AdapTech and participate in hands on
workshops that teach about clean water, farming and
gardening techniques, appropriate technology, and even
edible bugs. We will also have the opportunity to pick
blueberries from the on-site blueberry bushes.
Most importantly, we will start each day together with the
Lord in devotion and close out each night with dynamic
worship, storytelling, Bible study, small groups, and even
some games. We will conclude our time at SIFAT by
serving in the community of Lineville and will celebrate
with a cookout made by SIFAT’S farm to table interns.
After an amazing week at SIFAT, we will make our way back
to Houston with a stop at Whitewater Alabama in Phenix
City where we will raft the Chattahoochee River. A rafter’s
paradise, this section of the Chattahoochee was designed
and built in 2013 to offer custom trips ranging from mild
to wild. We will float, paddle, and splash our way through
Class I-IV rapids and are certain to have a fantastic time.
You don’t want to miss this Summer Experience!
LINEVILLE, AL
COST & FUNDING
The total cost of this trip per person, including; transport, room and board, food, t-shirt, and fun day is
$696.75. As with past years, we expect to raise one-third of the cost of this trip through our Student
Mission Sunday Silent Auction and Clay Shoot Fundraiser. This event will take place on Sunday, March 31,
2019. All students who plan to attend the mission trip should be available to assist on that day during the
Sunday services and at the luncheon.
The student is responsible for $464.50. We strongly encourage the students to raise one-half of this
amount ($232.25) by writing letters to family and friends. A sample fundraising letter is attached to this
packet. We believe writing letters encourages the student’s community to support them both prayerfully
and financially, and invest in the work they are doing and the work God is doing through these trips.
A non-refundable deposit of $150 is due at registration. Payment must be received in order to
guarantee a spot on trip. Registration and deposit DUE March 31, 2019. We have to give final
numbers and payments to SIFAT by April 1, 2019. You have until June 1 to turn in all forms and final
payments. All payments for the Mission Trip are considered a contribution to church and therefore
are non-refundable.
We never want cost to be a reason a student cannot attend an event, limited scholarships are available.
Please contact Lindsey for scholarship qualifications and the scholarship application.
Total Cost per Participant ………………………………….……$696.75
1/3 Covered by Student Mission Sunday Fundraiser …………$232.25
1/3 Student Responsibility …………………………………….$232.25
1/3 Support from Family & Friends …………………………..$232.25
HOUSING & ACCOMMODATIONS
We will be staying at the beautiful facilities located on SIFAT’s 176-acre farm in Lineville, AL. Their address
is 2944 County Road 113, Lineville, AL 36266
• The Lodge which sleeps 75 ( 2 bunk rooms & 4 suites). Each bunk room and suite has their own
bathroom with multiple showers and stalls. Large meeting space and a porch overlooking the creek.
• The International House which sleeps 26 (4 suites, each with own bathroom)
There are photos of the Lodge’s and International House’s sleeping accommodations and large meeting
room on the following page. Also check SIFAT’s website sifat.org or find them on Facebook, @sifatbook for
more photos of their acreage.
LINEVILLE, AL
HOUSING & ACCOMMODATIONS CONT.
Bunkroom in the LodgeLarge Meeting Room in the Lodge
Suite in International House
Outdoor Chapel
LINEVILLE, AL
SIFAT Farm View
SCHEDULE OVERVIEW
Saturday, June 22, we will meet at Grace Presbyterian Church @ 9:00 PM to check-in and load up the
buses. We will depart for Lineville, Alabama at 10:30 PM
Sunday, June 23, we will arrive at SIFAT at 1 PM after stopping for breakfast and lunch on the road. We will
check-in unload and settle in. We will meet the SIFAT staff and interns who will give us an orientation.
Sunday afternoon - Friday morning we will be on-site at SIFAT
Friday, June 28, we will load up the buses and head back to Houston at 10:30 AM stopping at 12:00 PM in
Phenix City, AL to enjoy some whitewater rafting.
Saturday, June 29, we will arrive back in Houston at Grace Presbyterian Church at 7:00 AM
MEALS
While at SIFAT all of our meals will be provided by them. This will be some of the most fresh and delicious
camp food, as SIFAT is a working farm. Please let us know if your child is allergic to any foods, so we can
share this info with SIFAT.
*Students will be responsible for 4 meals on the road (1 breakfast, 2 lunches, 1 dinner).
EXTRA SPENDING MONEY
Students will be responsible for 4 meals on the road (1 breakfast, 2 lunches, 1 dinner). The places we will
stop will be inexpensive.
We recommend providing your student with about $40-45 for meals and snacks on the road. The students
can also bring their own snacks.
MEDICINE POLICY / HOSPITAL INFORMATION
• If your child has a prescription medication or needs an over-the-counter medicine during the extent of
the trip, please enclose in a plastic bag with student’s name and dosage amount/times/etc. and turn in at
Check-In. We will have a nurse or volunteer leader in charge of making sure students take their
medications accordingly.
• The closest hospital to SIFAT is located about 20 minutes away in Ashland, AL. — Clay County Hospital /
83825 Highway 9, Ashland, AL 36251 / 256-354-2131
LINEVILLE, AL
SIFAT Sample Daily Schedule
DAY TIME ACTIVITY
SUNDAY 2:00 PM Students arrive/ Get to know you games
3:00 PM Orientation and Staff Introductions
3:30 PM Meet & Greet Games w/ Family Groups and Adult Meeting
4:15 PM Prepare for Hike
4:45 PM Meet with Family Groups / Hike to Global Village
5:00 PM Global Village Experience
5:30 PM Dinner
6:45 PM Speaker/Worship
7:30 PM Devo & Global Village Experience Continued
MONDAY 8:00 AM Breakfast
9:00 AM Global Village Tour
11:00 AM Urban Poverty Experience
5:30 PM Debrief Family Group Time
6:30 PM Dinner
7:30 PM Worship
TUESDAY 8:00 AM Breakfast
group will be divided
in half on Tues. and
Wed. with half of the
group following
Tuesdays Schedule
and the other half
following
Wednesdays
Schedule and then
switch.
8:30 AM Devo
9:00 AM walk to North Farm
9:35 AM App-Tech @ North Farm
12:00 PM Lunch
1:00 PM App-Tech @ North Farm
6:00 PM Dinner
7:30 PM Back at base camp
8:30 PM Worship and Devo
WEDNESDAY 7:15 AM Blueberry Picking Group 1
8:00 AM Breakfast
8:30 AM Devo
9:00 AM Family Group Time
9:30 AM Challenge Course
12:00 PM Lunch
1:00 PM Rotating Learning Stations
3:15 PM Free Time
6:00 PM Dinner
7:30 PM Worship/Devo/Family Group Time
THURSDAY 7:15 AM Blueberry Picking Group 2
8:00 AM Breakfast
9:15 AM Family Group Time
10:00 AM Depart for Community Sites in Lineville
2:00 PM Leave Community Sites
4:00 PM Soccer Cookout with Lineville community
7:30 PM Worship/Devo/Family Group Time
FRIDAY 7:15 AM Blueberry Picking Group 3
8:00 AM Breakfast
8:30 AM Outdoor Devo
9:00 AM Clean Lodging
9:45 AM Village Store Open
10:00 AM Depart for Home
�1
WHITE WATER ADVENTURE
On our way back to Houston we will stop at Whitewater Alabama located in Phenix City and go on a
guided raft adventure along the Chattahoochee River. This is a great place for all skill levels, whether it is
your first time on a whitewater raft or you have been on multiple trips you are sure to enjoy this
experience!
whitewateralabama.com/rafting
ADULT CHAPERONES AND LEADERSHIP
Grace Student Ministries has been blessed with an abundance of leaders who have a desire to walk
alongside students and point them to their Savior and Creator. Because safety, health, spiritual growth, and
the well-being of our students is extremely important to us, we require 1 leader for every 5 students who
attend this trip. Each of our leaders are required to go through numerous background checks, successfully
complete an ECO training program, and much more. We are extremely thankful for the dedication and
hard work that our leaders give to the ministry and our students!
CELL PHONE POLICY
Students are allowed to bring cell phones. They will be allowed to have them on the travel days. Once we
arrive at SIFAT (Sunday afternoon - Friday morning) leaders will collect everyone’s phones. Cell
Service is extremely limited at SIFAT. When the leadership team did a site visit, we experienced losing
cell phone service while on location.
If you need to get a hold of your child while at SIFAT, please call one of the Grace staff leaders’ cell
phones or the SIFAT main office: (256) 396-2015
GRACE CONTACT INFORMATION PRIOR TO TRIP
Lindsey McDonald Monica Cvejanovich
713-267-5067 713-267-5011
[email protected] [email protected]
LINEVILLE, AL
PACKING LIST *
• Radios, iPads, Tablets, Electronic Games, TVs, etc.
• Anything that is not replaceable or has significant value, like expensive jewelry or laptops. DO
NOT BRING A LOT OF MONEY OR VALUABLES.
• Drugs, alcohol, vapes, juules, knives, guns, weapons of any kind, etc. If a student is caught with
any of these in his/her possession, the item(s) will be confiscated and the student’s parents will
be contacted. The student will be sent home immediately at the parent’s expense.
LINEVILLE, AL
PERSONAL ITEMS:
• Personal Medications (will be given to an adult leader at check-in and distributed as needed.)
• Aloe Vera Gel
• Bandana
• Bath Towel
• Beach Towel
• Washcloth
• Wet wipes
• Toothbrush
• Toothpaste
• Brush
• Soap
• Deodorant
• Shampoo/Conditioner
• Laundry Bag
• Work gloves
• Blanket for bus
• Snacks for Bus
• Extra Spending Money for meals on the road (around $40)
MUST HAVES:
Bible/Journal/Pen
Water bottle
Hat/Baseball Cap
Sleeping bag for camping 2 nights
twin sheets for mattress
Pillow
Bug Spray!!!
Sunscreen!!!
CLOTHING:
• Camp clothes (Athletic Shorts - NO Lululemon shorts - T-shirts - NO tank tops)
• 1 pair of jeans
• Pajamas
• Comfortable travel clothes for bus ride
• Swimwear (girls modest one-piece / boys no speedo)
• Water Shoes for rafting
• Flip-flops / Shower shoes
• Tennis Shoes - Closed toe for
DO NOT BRING
Sample Support Letter
Dear ______________________,
From June 22-29, I have the opportunity to travel to Lineville, Alabama with Grace Presbyterian Church’s
Student Ministries. We will participate in a week long Learn & Serve Mission Experience led by a
Christian missions training organization,
Servants in Faith and Technology (SIFAT). SIFAT
exist to help people from different countries,
cultures and social classes understand each
other and work together, so that every person
can have a chance to develop into the person
God intends for each to be. They desire to
bring the Kingdom of God closer to all.
While at SIFAT, our group will learn how to walk
with the Lord to bloom personally and within
our communities for His glory and our good. We will have time to spend with SIFAT graduates from
Congo and Uganda to learn about specific needs in their regions and what God is doing through His
people to meet them. We will also have the opportunity to learn about and serve in the local community
of Lineville. Most importantly, we will start each day together with the Lord in devotion and close out
each night with worship, storytelling, Bible study, and small groups. At the end of this experience, our
group hopes to return to our community with an understanding of what it means to think globally and
act locally, and to have shared in an experience that will renew in us an excitement about the restorative
work Jesus Christ is doing in the world and in our lives, and the invitation to be a part of this work of
restoration.
I would like to invite you to consider partnering with our group, first through prayer. Please
consider praying for this mission experience. Pray for the group - that we would be open to learning
from the community we are visiting and grow closer as a group and closer to Jesus. Pray for the staff and
leaders who will be leading us during the trip. Pray for the people in the community who we will meet -
that we could love and honor them well. Finally, pray for me — that I could keep an open heart to the
people around me and to how God is revealing himself to me during the week. Please let me know, if
you will commit to praying for us. I would love to share that news with my group.
Secondly, I would invite you to please consider partnering with our group financially. Each person
on our team has been asked to raise $232.25. If 5 people gave $26.45, 4 people gave $25. I would
reach my goal. That being said, I am grateful for any amount you may feel led to give. If you would like
for your gift to be tax-deductible, please make the check out to “Grace Presbyterian Church.” Please
mail all financial gifts to:
[STUDENT NAME]
[STUDENT ADDRESS]
Thank you for considering supporting us through prayer and/or giving. This trip would be impossible
without the generosity of so many. I am excited for this opportunity, and I look forward to sharing about
this experience with you when I return.
Sincerely,
[STUDENT NAME]
2019 GRACE MISSIONS COVENANT
1 CORINTHIANS 10:31: Therefore, whether you eat or drink, or whatever you do, do all to the glory of God.
I UNDERSTAND THAT BY SIGNING THIS COVENANT, I AGREE TO ABIDE BY ALL RULES OR RISK BEING SENT HOME AT PARENT’S EXPENSE:
ACTIONS CONSEQUENCE
Purchase, consumption or possession of any vapes/juules, smoking/ Sent home at parents’ expense tobacco products, alcohol, or any non-alcoholic frozen drinks, (call/taxis/extra flight, etc.) weapons, or drugs.
Guys & Gals: It is important that we stay above reproach and hold ourselves Sent home at parents’ expense to a high standard when it comes to our interaction with the opposite sex. We need your help in avoiding any situations that may be perceived as inappropriate. - No opposite gender in your room at any time
Clothing: Our goal is to be as modest as possible for the culture Confiscate clothing we will serve and for our group’s goal. - No short shorts for any reason. - Please wear regular t-shirts with full sleeves. - One-piece modest bathing suits only. No spaghetti straps, tummy baring, or immodest clothing for the night. - If you question an item of clothing—don’t bring it.
Electronics: We want to spend this week focusing on the service Confiscate item for length of trip and people God has put before us. Please leave the following at home:
- iPads, tablets, PSP, MP3 players, CD players, etc
Sleep and Meals: We’ve got to eat and rest in order to maintain our stamina and health while serving. Both are vital on our trip. Verbal warning - Everyone is expected to eat 3 meals each day. Meeting with staff/leaders - Respect your roommates’ and the groups’ need for rest
Showing Respect: Please show respect by listening when others are talking; Verbal warning whether it’s one of our new friends, leaders, or friends. Meeting with staff/leaders
- Refrain from gossiping or abasing others. Sent home at parents’ expense - No FOUL LANGUAGE
Damage to Accomodations/Buses, etc: We need your help in respecting and honoring You will pay for the damages and the places we get to stay and use. Remember you are representing yourselves, your family, be sent home at parents’ expense. Grace Church, and Jesus Christ. - All facilities should be left clean and in order. Staff/Leader Responsibilities: It is our job to help protect and care for you on this trip. - At all times, Grace staff has the authority to modify or implement the covenant to fit the needs of different circumstances that may arise
Student Responsibilities: Along with keeping the covenant yourself, we expect that you help everyone stay accountable to the covenant In confidence, we expect that you will inform a leader if you become aware of the covenant being broken. By not reporting covenant infractions you jeopardize: the safety of the group, the leaders, and risk being seen as associated or a participant in the infraction.
________________________________________________________________ _____________________ Parent’s Signature Date
_________________________________________________________________ _____________________ Student’s signature Date
_______________________________________________________________________ Printed Name of Student
2019-2020PERMISSIONSLIP,WAIVER,MEDICALAUTHORIZATIONANDRELEASE
NameofStudent_________________________________________________HomePhone____________________
Address_______________________________________________________________________________________
City______________________________________________State______________________Zip______________
Studentemailaddress___________________________________________________________________________
Parentemailaddress____________________________________________________________________________
Parent(s)and/orLegalGuardian(s)_________________________________________________________________
Cell/Pager/WorkNumbersofParent(s)and/orLegalGuardian(s)__________________________________________
_____________________________________________________________________________________________
AgeofChild:_____BirthDate:_____________Gender:_____Grade:_____School:________________________
FUNCTIONSANDACTIVITIES
ItismyunderstandingthatparticipatingintheprogramsandrecreationalandotheractivitiesofGracePresbyterian
Church(“theChurch”)isaprivilege.Priortomystudent’sparticipationinsuchactivities,Iacknowledgethatcertainrisksare
associatedwiththeactivities,including,bywayofexample,physicalinjuryduetoactivityrelatedaccidents,physicalinjury
duetotransportationrelatedaccidents,illnessorevendeath.Inaddition,Iacknowledgethattheremaybeotherrisks
inherentintheseactivitiesofwhichImaynotbepresentlyaware.Theundersignedherebygiveourconsenttoand
authorizetheminorchildnamedabovetoparticipateinalleventsconductedbytheChurch.Ifurtherauthorizemyminor
childtotravelwithrepresentativesoftheChurchinprivateorothervehiclestoanysucheventssoconducted.
PUBLICITY
Onoccasion,theChurchtakesphotographsormakesanaudioorvideotaperecordingofstudentsand/oradultsinvolvedin
churchactivities.Suchphotographsorvideorecordsmaybeusedbystaffandparticipantstoremember
theactivitiesandparticipants.Inaddition,suchphotographsandaudio/visualrecordingsmaybeusedinGrace
PresbyterianChurchpublicationsoradvertisingmaterialstoletothersknowaboutourministry.Inaddition,localnews
organizationsmayhearofouractivitiesorevents,andourChurchmayallowthemtophotographorrecordoureventsfor
newsreportingonspecialinterestfeatures.
Iconsenttotheuseofanysuchaudioorvisualrecordofthechildnamedabovetobeused,distributed,or
displayedasagentsoftheChurchseefit.Thisconsentincludesbutisnotlimitedto:photographs,videotape,audio
recordings,andtheChurch’swebpage.____Yes___No
Continuedonbackside…..
FIRSTAIDANDEMERGENCYMEDICALTREATMENT
Irecognizethattheremaybeoccasionswhenthestudentnamedabovemaybeinneedoffirstaidoremergencymedical
treatmentasaresultofanaccident,illness,orotherhealthconditionorinjury.Idoherebygivepermissionforagentsofthe
Churchtoseekandsecureanyneededmedicalattentionortreatmentforthestudentnamedincludinghospitalization,ifin
theopinionoftheagentsuchaneedarises.
Further,IauthorizetheagentoftheChurchtoconsenttoanyX-rayexamination,anesthetic,medicalorsurgicaldiagnosisor
treatmentandhospitalcarewhichisdeemedadvisableby,andisrenderedunderthegeneralorspecialsupervisionof,any
physician,surgeon,ordentistlicensedunderthelawsoftheStateorCountyinwhichthemedicalcareisbeingsoughtand
onmedicalstaffofanyhospital.IndoingsoIagreetopayallfeesandcostsarisingfromthisactiontoobtainmedical
treatmentincludinganytreatmentaphysician,surgeon,ordentistmaydeemnecessary.
RELEASEOFLIABILITY
Bysigningthisform,Iexpresslywarrantthatthestudentnamedaboveiscapableofwithstandingboththephysicaland
mentaldemandsoftheactivitiesdiscussedabove.Ialsoexpresslyassumeallrisksofthechildparticipatingintheactivities,
whethersuchrisksareknownorunknowntomeatthistime.I,theundersigned,formystudent,mystudent’spersonal
representatives,assigns,heirs,distributees,guardians,andnextofkin(“theReleasors”),herebyirrevocablyand
unconditionallyrelease,waive,discharge,andcovenantnottosuetheChurchanditsministers,leaders,employees,
volunteers,andagents,forandfromallclaimsofanynaturenoworhereafterexistingwhetherknownorunknown,
includingbutnotlimitedto,allliabilitytotheReleasors,onaccountofinjurytomychildordeathtomychildorinjurytothe
propertyofthechild,whethercausedbythenegligenceoftheChurch,itsministers,leaders,employees,volunteers,and
agentsorotherwise,duringthecourseofmystudent’sparticipationintheactivities,arisingoutoforin
connectionwithactivitiesrelatedtotheChurch,oranytravelconnectedtherewith.
MEDICALHISTORY
Specialmedicalneedsorconcerns(allergies,conditions,dietaryneeds,medications,etc.):________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
HealthInsurance
InsuranceCompany_________________________________________PhoneNumber____________________PolicyNumber_________________
MedicalDoctor_______________________PhoneNumber_______________DateofLastTetanusShot_________
Intheeventthatparent(s)and/orlegalguardian(s)cannotbereached,call(Name&PhoneofEmergencyContact):
________________________________________________________________________________________________________
OtherInformation
Otherinformationchurchleadersshouldknowaboutthechild
________________________________________________________________________________________________________
PARENTORGUARDIANSIGNATURE
IrepresentthatIamtheparent/guardianof________________________________,whoisunder18yearsofage.Ihavereadtheabove
formandamfullyawareofthecontentsthereof.Igivepermissionforthestudentnamedabovetoparticipateinthe
activitiesofGracePresbyterianChurch,includinganyspecialevents/activities.Inconsiderationforallowingthe
participationofthestudentintheactivitiesoftheChurch,Iherebyconsenttotheabovetermsonbehalfofthechildand
agreethatthisformshallbebindinguponme,myfamily,heirs,legalrepresentatives,successors,andassigns.
_______________________________________________________________________________________________________
SignatureofParentorLegalGuardian Date
________________________________________________________________________________________________________
PrintNameofParentorLegalGuardian
YOUNGPERSON’SAGREEMENT
IagreetoparticipateinthefunctionsandactivitiesoftheChurch,tocooperatewiththeleadersandotheryoungpeople,and
toconductmyselfaccordingtoChristianvalues.IpromisetorespectGod,respectmyself,respectotherpersons,andrespect
property.Iunderstandthatmycontinuedparticipationinchurchactivitiesdependsonmysupportofthisagreement.
_________________________________________________________________________________________________________
Student’sSignature Date
Individual Student Medical Release Form
SIFAT does not insure visitors/participants and is not responsible for any bodily injury that may occur during time spent on SIFAT property.
Group Name _______________________________________________________________________ Participant’s name______________________________________ Gender ________ Age:_____
Parent or legal guardian _________________________________________________________________________________
Address______________________________________________________________________________________________
_____________________________________________________________________________________________________
Phone number: day_____________________________ night_____________________________
Emergency contacts:
Name_________________________________________________________________________________________
Relation to participant____________________________________________________________________________
Phone number: day___________________ night__________________________________________________
Name__________________________________________________________________________
Relation to participant_____________________________________________________________
Phone number: day___________________ night___________________________________
Physician______________________________________________________________________________
Physician’s Phone ________________________________________________________________________
Insurance agency _____________________________________________________________
Policy Number, Policy Holder Name & DOB______________________________________________________________
Known allergies:_________________________________________________________________________
Medication(s):___________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
Special needs: _________________________________________________________________________________________
Dietary needs: _________________________________________________________________________________________
I, ______________________________ (parent/legal guardian), hereby acknowledge that SIFAT is not responsible for any
injury my child may incur during his/her time spent at SIFAT. I further release from any liability SIFAT and its Staff and/or
leadership in the event of any accident. I also give my child permission to take part in creek and lake activities, which are
a part of the Learn & Serve program. I authorize _________________________ (group leader) to seek appropriate
medical attention if needed.
________________________________________
(Signature of parent/legal guardian)
__________________________________
(Date)
CHATTAHOOCHEE RAFTING COMPANY, INC.
DBA WHITEWATER EXPRESS
Waiver and Release of Liability Name: __________________________________ Age: ____________ Gender: M / F (circle one) Group Name: ____________________________ Group Leader: ____________________________ Date(s) of stay at WhiteWater Express: _____________________
In Consideration of Chattahoochee Rafting Company, Inc. furnishing services and/or equipment to enable me to participate in rafting, ropes course, horseback riding, mountain biking, canoeing, kayaking, camping, tubing, and other activities, I agree as follows:
I fully understand and acknowledge that outdoor recreational activities have (a) inherent risks, dangers, hazards, and such exist in my use of Chattahoochee Rafting Company, Inc. equipment and my participation in such activities; (b) my participation in such activities and/or use of such equipment may result in injury or illness including, but not limited to, bodily injury, disease, strains, fractures, partial and/or total paralysis, death or other ailments that could cause serious disability; (c) these risks and dangers may be caused by the negligence of the owners, employees, officers, or agents of Chattahoochee Rafting Company, Inc., Uptown Whitewater Management L.L.C., Columbus Consolidated Government, Georgia Power, Phenix City Alabama and the United States; the negligence of the participants, the negligence of others, accidents, breaches of contract, the forces of nature, or other causes. Risks and dangers may arise from foreseeable or unforeseeable causes including, but not limited to, guide decision making, including that a guide may misjudge terrain, weather, trail or river route location, and water level, risks of falling out of or drowning while in a raft, canoe, or kayak and such other risks, hazards, and dangers that are integral to recreational activities that take place in a wilderness, outdoor, or recreational environment; and (d) by my participation in these activities and/or use of equipment, I hereby assume all risks and dangers and all responsibility for any losses and/or damages whether caused in whole or in part by the negligence or other conduct of the owners, agents, officers, or employees of Chattahoochee Rafting Company, Inc., Uptown Whitewater Management, L.L.C., Columbus Consolidated Government, Georgia Power, Phenix City Alabama or the United States, or by any other person. In addition, I hereby grant permission to Chattahoochee Rafting Company, Inc. to make and use for promotion or other purposes, photographic records without recourse or compensation to me.
I, on behalf of myself, my personal representatives, and my heirs hereby voluntarily agree to release, waive, discharge, hold harmless, defend, and indemnify Chattahoochee Rafting Company, Inc., the Uptown Whitewater Management, L.L.C., Columbus Consolidated Government, Phenix City Alabama and the United States, and its owners, agents, officers, and employees from any and all claims, actions, or losses for bodily injury, property damage, wrongful death, loss of services, or otherwise which may arise out of my use of Chattahoochee Rafting Company, Inc. equipment or my participation in Chattahoochee Rafting Company, Inc. activities. I specifically understand that I am releasing, discharging, and waiving any claims or actions that I may have presently or in the future for the negligent acts or other conduct by the owners, agents, officers, or employees of Chattahoochee Rafting Company, Inc., the Uptown Whitewater Management, L.L.C., Columbus Consolidated Government, Phenix City Alabama and the United States.
The venue of any dispute that may arise out of this agreement or other-wise between the parties to which Chattahoochee Rafting
Company, Inc. or its agents is a party shall be either the Phenix City, Alabama Justice Court or State Supreme Court in Russell County Alabama.
I HAVE READ THE ABOVE WAIVER AND RELEASE. BY SIGNING IT, I AGREE IT IS MY INTENTION TO EXEMPT AND
RELIEVE CHATTAHOOCHEE RAFTING COMPANY, INC., UPTOWN WHITEWATER MANAGEMENT, L.L.C., COLUMBUS
CONSOLIDATED GOVERNMENT, GEORGIA POWER, PHENIX CITY ALABAMA, AND THE UNITED STATES FROM
LIABILITY FOR PERSONAL INJURY, PROPERTY DAMAGE, OR WRONGFUL DEATH CAUSED BY NEGLIGENCE OR
ANY OTHER CAUSE.
Signature: _______________________________ Date: ____________ Parent/Guardian Signature (if under 18): _______________________________ Date: ____________