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RELEASE OF LIABILITY
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AND
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INSURANCE INFORMATION
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Summer, 2012
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Return this Release at time of registration or no later than May 1, 2012
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This form maybe submitted directly online from the web site, or mailed to Winter
Address: Echo Hill Ranch, 8601 Georgia Ave, Suite 810, Silver Spring, MD. 20910
or faxed to: 301-588-4041
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Camper may not participate in camp activities until this form is on file.
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IF YOUR
MINOR CHILD IS ATTENDING THE CAMP: I hereby grant permission for my son/daughter, to attend
and participate in all camp activities at Echo Hill Ranch this summer. I understand
that Echo Hill Ranch will provide supervision for all activities and make sure that
every reasonable effort will be made to ensure the safety of all participants. I
release the owners of Echo Hill Ranch, Inc., and their employees , and the owners
of the land known as Echo Hill Ranch, from any liability for any injury or illness
to my son/daughter.
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In case of an illness or injury, if I cannot be reached after reasonable efforts,
I give Echo Hill Ranch, Inc. the authority to act in my behalf for the care and
treatment of my son/daughter.
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In the event of illness or injury I hereby give permission for Echo Hill Ranch,
Inc. staff to take my child to Sid Peterson Memorial Hospital in Kerrville, Texas
or the nearest physician and/or hospital for appropriate treatment. In the event
that I cannot be reached after reasonable efforts, I give permission to Sid Peterson
Memorial Hospital and the physicians at the Hospital or others selected by Echo
Hill Ranch staff to hospitalize, secure proper treatment for, and to order injection,
anesthesia or surgery if necessary.
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I agree to be responsible for all medical expenses related to the treatment of my
child.
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IF YOU
ARE AS AN ADULT ARE ATTENDING AN EVENT AT ECHO HILL RANCH: I,
am of adult age and will be attending an event at Echo Hill Ranch this summer. I
release the owners of Echo Hill Ranch, Inc., their employees, and the owners of
the property known as Echo Hill Ranch from any liability for any injury or illness
to me. I understand that Echo Hill Ranch will provide supervision for all planned
activities and make sure that every reasonable effort will be made to ensure the
safety of all participants. In case of an illness or injury, if I or an adult emergency
contact I have identified, cannot respond within reasonable time, I give Echo Hill
Ranch the authority to act in my behalf for my care and treatment. In the event
of illness or injury I hereby give permission for Echo Hill Ranch staff to take
me to Sid Peterson Memorial Hospital in Kerrville, Texas or the nearest physician
and/or hospital for appropriate treatment. In the event that I or an emergency contact
I have identified cannot be reached after reasonable efforts, I give permission
to Sid Peterson Memorial Hospital and the physicians at the Hospital or others selected
by Echo Hill Ranch staff to hospitalize me, secure proper treatment, and to order
injection, anesthesia or surgery if necessary. I agree to be responsible for all
medical expenses related to my treatment.
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All information below must be completed so
we can quickly access health care or prescriptions for your child if necessary:
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Echo Hill Ranch
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Summer Telephone: 830-589-7739 Summer Fax: 830-589-2520
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Email: EHranch@aol.com www.echohill.org
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Revised 8/11
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