WCRC Medical Information and Informed Consent Waiver

Faith Adventures is a challenge/ropes course involving a series of group initiatives, team-learning and character building activities. The activities use natural and man-made resources including ropes, cables, walls, ladders, and other resources in a wooded setting. Low Ropes activities occur within 10 feet of the ground.

High Ropes Course participants (including Zip Line, Tree Climb, and Super Swing) ascend up to 65 feet from the ground. A trained instructor leads the participants in the activities. Due to rescue scenarios there is a 250 pound weight limit for high ropes, tree climb and zip line and super swing.

WCRC Informed Consent

Williamsburg Christian Retreat Center Faith Adventures Ropes Course Medical Information and Informed Consent

Participant's Name(Required)

First Last

*If the participant is under age 18, the signature at the bottom must be a parent or legal guardian.

Group Name / School(Required)

First Last

Your Address(Required)

Street Address Address Line 2 City ZIP Code

Your Phone(Required)

In case of emergency contact: (Name and Phone)

List known allergies:

List required medications:

Check if true:

Allergic to bee stings?

If allergic to bee stings, has a bee sting kit?

Wear contact lenses?

Pregnant?

Had or have diabetes, asthma, angina, epilepsy, chest pains, drug reactions, high blood pressure, heart murmur?

Ever had a heart attack?

Any serious disease or surgery?

Any other details or medical conditions we should be aware of?

Name(Required)

First Last

I am not under the influence of any chemical substance including alcohol. I understand that any physical activity involves a risk of injury. I also understand that my participation in the Williamsburg Christian Retreat Center ropes course is entirely voluntary. I give permission for photographs or video that include myself (my son, or daughter) to be used in publicity. Primary insurance covering any accidents that might occur during my participation in the Faith Adventure Ropes Course is the responsibility of my church, organization, or family. I release Williamsburg Christian Retreat Center, its’ owners, employees and staff, from any claims or liability arising out of my participation. Typing my name into this form is equivalent to signing a legal document.

Date(Required)