Declaration of Medical Information and Liability Release
The information provided is a complete and accurate statement of the physical and psychological factors that may affect participation at AboutFace’s Adult Retreat. I realize that failure to disclose such information could result in harm to myself or fellow attendees, and agree to indemnify and hold AboutFace and its directors, officers, employees, agents and affiliates harmless from any liability for any harm sustained to myself arising from my failure to fully disclose such information.
To the best of my knowledge, I am in good health and have not been exposed to any infectious disease in the past four weeks. If I become exposed to any infectious disease between now and the time of departure for the Adult Retreat, or have any change in medical health, I understand that AboutFace must be notified in writing. In case of surgical emergency, and I am incapacitated and my emergency contact is unable to give consultation, I hereby give permission to the Physician selected by the Camp Director to hospitalize, secure proper treatment for and to order injection, anesthesia or surgery.
I hereby waive, release and absolve and agree to indemnify and save harmless AboutFace and its directors, officers, employees, agents and affiliates of and from any and all liability arising from my attendance at Adult Retreat, except such as shall arise solely as a consequence of its or their willful negligence or willful default. If, for any reason, I require medical attention or special medication beyond that furnished by the retreat, I agree to be responsible for any expenses incurred.