Good Grief! Kids Camp – Walsenburg

I voluntarily agree to assume all risks of loss that arise out of my or my child’s participation and agree to waive any and all claims against Sangre de Cristo Hospice and the other parties involved. I hereby release, and agree to indemnify and hold harmless Sangre de Cristo Hospice and any of their respective employees, agents, officers, representatives, successors, assigns, and insurers from liability for any injury, loss or damage to my person, my child, or property, whether anticipated or unanticipated, resulting from my participation in any activities contemplated including transportation to and or from set activity by this Agreement.

I am aware of the possible risks inherent in my or my child’s participation and do hereby assume sole responsibility for all such risks and waive all claims against Sangre de Cristo Hospice and their respective agents, representatives, officers, employees, successors, assigns, and insurers.
I agree that my child or I will abide by the rules of the program while participating. I hereby acknowledge that I have read, understood and voluntarily agreed to the foregoing waiver and release agreement.

It is understood that the medication is administered solely at the request of and as an accommodation to the undersigned parent or guardian. In consideration of the acceptance of the request to perform this service by the camp nurse or other qualified medical staff of Sangre de Cristo Hospice & Palliative Care. The undersigned parent or guardian hereby agrees to release Sangre de Cristo Hospice & Palliative Care and its personnel from any legal claim which they now have or may hereafter have arising out of side effects or other medical consequences of the medication.

I grant Sangre de Cristo Hospice & Palliative Care the right to take photographs of me, my family or art work created by myself in connection with a Sangre de Cristo event. I authorize Sangre de Cristo Hospice & Palliative Care, its assigns and transferees to copyright, use and publish the same in print and/or electronically.

I agree that Sangre de Cristo Hospice & Palliative Care may use such photographs associated to me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and web content. My attestation below signifies agreement with the following:

1. I will receive no compensation.

2. To release and discharge Sangre de Cristo Hospice & Palliative Care’s board of Directors, management, staff, volunteers or its agents from any liability for claims by me or anyone else that rises from information that may appear in printed materials, recordings or televised programs.

3. Sangre de Cristo Hospice & Palliative Care, or other hospice organizations, may copyright and use photographs or biographical narrative.

4. Sangre de Cristo Hospice & Palliative Care may use diagnosis, care, treatment and general information concerning the participant.

5. This release, and the rights granted herein, shall remain in effect until revoked in writing by the undersigned or his/her representative. If representative wishes to revoke this agreement, please forward, in writing, a revocation notice to:

The Privacy Official
Sangre de Cristo Hospice & Palliative Care
1207 Pueblo Blvd. Way, Pueblo, CO 81005.

Revocation of this agreement will not be effective for patient/client’s past participation in documented activities.