Forms – The Rock Texas

Forms and Background Check

Download and print each one of the forms below. Please fill them out and bring them with you to the event.

ADULT HUNTING PARTICIPATION AGREEMENT

Agree

PHOTO RELEASE AGREEMENT

Agree

Disagree

MEDICAL RELEASE FORM

Name

Signature

Medical Release Form

Parent/Legal Guardian’s Name:_________________________________________________________________________ Address:___________________________________________________________________________________________ Phone #’s: Home_______________________________ Work________________________________ Cell_________________________________ Other_______________________________ In an emergency, please contact:_______________________________________________________________________ Relationship to child:________________________________________________________________________________ Phone #’s: 1.__________________________________________ 2._______________________________________ 3.__________________________________________ 4._______________________________________ Or Contact:_________________________________________________________________________________________ Relationship to child:_________________________________________________________________________________ Phone #’s: 1.__________________________________________ 2._______________________________________ 3.__________________________________________ 4._______________________________________ Physician’s Name:___________________________________________________________________________________ Address:___________________________________________________________________________________________ Phone #’s: 1.__________________________________________ 2._______________________________________ Dentist’s Name:_____________________________________________________________________________________ Address:___________________________________________________________________________________________ Phone #’s: 1.__________________________________________ 2._______________________________________ Primary Insurance Company:___________________________________________________________________________ Phone #’s: 1.__________________________________________ 2._______________________________________ Child Name List all Known Medical Conditions, Including Food Allergies and/or Drug Allergies. In Addition, Include Any and All Over-the-Counter and/or Prescription Drugs Taken Regularly. 1 Billing Address:______________________________________________________________________________________ Policy Holder’s Name:________________________________________________________________________________ Address:___________________________________________________________________________________________ Relationship to child:_________________________________________________________________________________ ID #:_________________________________________ Group/Policy #:_______________________________________ Secondary Insurance Company:________________________________________________________________________ Phone #’s: 1.___________________________________________ 2.______________________________________ Billing Address:______________________________________________________________________________________ Policy Holder’s Name:________________________________________________________________________________ Address:___________________________________________________________________________________________ Relationship to child:_________________________________________________________________________________ ID #:_________________________________________ Group/Policy #:_______________________________________ We will need a copy of your driver’s license and copy of front & back of your insurance card. Statement of Consent: (To be signed in the presence of a legalized notary public.) In the event of an emergency or non-emergency situation requiring medical treatment, I, ____________________________________, hereby grant permission for any and all medical and/or dental attention to be administered to my child, in the event of an accidental injury or illness, until such time as I can be contacted. This permission includes, but is not limited to, the administration of first aid, the use of an ambulance, and the administration of anesthesia and/or surgery, under the recommendation of qualified medical personnel. Signature:_______________________________________________ Date:___________________________________ THE UNDERSIGNED HAVE READ THE ABOVE WAIVER AND RELEASE AND THE NOTICE – LIMITATION OF LANDOWNERS’ LIABILITY ATTACHED TO THE BACK OF THIS WAIVER AND RELEASE. CONSENT, ACKNOWLEDEMENT AND AGREEMENT DATED __________________________________, 20_____________. Print Name: ________________________________ Address: ________________________________________________ Date of Birth: ____________________ Home Phone: ______________________ Work Phone: _____________________ Child Signature: ___________________________________________ Date:_____________________________________ Parent’s Signature: _________________________________________________________ Parent’s Name (Printed): _____________________________________________________________________________ Parent’s Phone: _____________________________________________________________________________________

ADULT HUNTING PARTICIPATION AGREEMENT

For and in consideration of being permitted to hunt, fish and/or visit with the Refuge Outfitters for Christ’s Kingdom (The ROCK) on any of the properties they utilize, manage, lease and/or own; Participant hereby executes this Consent and Release to the parties above, their agents, servants, employees and any other persons connected with them in said activities with the ROCK and any other properties they use, lease and/or own, and as against them, voluntarily releases, discharges, waives and relinquishes any and all actions or causes of action for personal injury, property damage or wrongful death occurring to him/her arising as a result of engaging in said activity or any activities incidental thereto wherever or however the same may occur and for whatever period said activities may continue, and Participant for himself/herself, his/her heirs, executors, administrators and assigns hereby releases, waives, discharges and relinquishes any action or causes or action, aforesaid, which may hereafter arise for himself/herself and for his/her, estate, and agrees that under no circumstances will he/she or his/her heirs, executors, administrators and assigns prosecute any of the parties above, or any of their agents, servants, employees and other persons connected with said properties they utilize, manage, lease and/or own, whether the same shall arise by the negligence of any of said persons or otherwise. Participant also agrees for himself/herself, his/her heirs, executors, administrators and assigns, that in the event of any claim for personal injury, property damage or wrongful death that be prosecuted against the ROCK or any of their agents, servants, employees and other persons connected with the ROCK and any other properties they utilize, lease and/or own, he/she indemnify and save them harmless from any and all said claims or causes of action by whomever or wherever made or presented. Participant acknowledges having read the foregoing paragraphs, that he/she has been fully and completely advised or the potential dangers incidental to the hunting activities, and is fully aware of the legal consequences attendant to signing/executing the Consent and Release.

Forms and Background Check

ADULT HUNTING PARTICIPATION AGREEMENT

PLEASE CONTACT US FOR MORE INFO.

© Copyright 2022 - 2021 | The Rock | All Rights Reserved | Design by THE PETTY COLLECTIVE