RETREAT FORM

2017 Island Youth High School Spring RETREAT LIABILITY FORM

This form must be completed by the parent/guardian of every participant for the Island
Youth 2017 High School Spring Retreat. We will be meeting in The Well (11F, 633 Kings
Road) at 6:00pm on March 3, 2017 and the retreat will conclude at 4:00pm on March 4,
2017 at the Causeway Bay MTR station. The retreat will cost $100 and will include
accommodation, dinner, breakfast, lunch and activities.

NAME OF PARTICIPANT: _________________________________________________________

(please print)

I, the parent/guardian of the participant listed above, give permission for my child to
attend the Island Youth High School Spring Retreat from March 3- March 4, 2017 at Lei
Yue Mun Park and Holiday Village in Shau Kei Wan, Hong Kong Island. I hereby waive
and release Island Youth and its organisers, including the employees and volunteers of
Island ECC, from all liabilities resulting from any damage, loss, personal injury or illness
to my child and/or my childs property arising from my childs participation. I permit the
camp organisers to release my child for medical care in case of injury or illness.

Name of parent/guardian: _______________________________________________________

(please print)

Signature of parent/guardian: ____________________________________________________

Contact number of parent/guardian: ______________________________________________

Contact email of parent/guardian: ______________________________________________

Date: ___________________________

Please submit the signed form with a $100HKD non-refundable camp fee (cash or
cheque payable to Island ECC ltd.) to the youth leader on or before March 3, 2017

Thank you!

Island Youth
youth@islandecc.hk
 Island Youth CWB Game
March 4, 2017
(the "Game")

Liability Waiver
in respect of

Full name of the participant: _______________________________ (the Participant)

I acknowledge that the Game can be a test of a persons physical and mental limits and carries with it
the potential for personal injury and property loss. The risks include, but are not limited to, actions of
other people including, but not limited to, participants, volunteers, event monitors and/or producers of
the Game; lack of hydration; weather and/or other natural conditions. As the parent of the Participant,
I hereby assume all of the risks of the Participant participating in the Game and acknowledge that the
sole responsibility for the Participants personal safety remains with me and the Participant at all
times during the Game.

I declare that the Participant is physically fit to participate in the Game and has not been advised
otherwise by a qualified medical person.

I acknowledge that this Liability Waiver will be relied on by GameMasters Limited and it will govern
the Participants actions during the Game and my responsibilities as aforementioned.

In consideration for the opportunity and permission to participate in the Game, I hereby take action
for myself, the Participant and the executors, administrators, heirs, next of kin, successors, and assigns
of me or the Participant as follows: (A) waive, release, and discharge GameMasters Limited and their
directors, officers, employees, volunteers, representatives and agents from any and all liability for the
Participants personal injury, property damage, or any losses whatsoever that may accrue to the
Participant during the Game, (B) indemnify and hold harmless all entities or persons mentioned in this
paragraph from any and all liabilities or claims made by other individuals or entities, including but not
limited to the owner, management or representatives of the venue at which the Game is held or uses,
intentionally or incidentally, as a result of the Participants actions during the Game.

I understand that during the Game or related activities, the Participant may be photographed or
videotaped by other Game participants and/or GameMasters Limited or their agents. I agree to allow
the photographs or videos of the Participant to be used by GameMasters Limited for marketing or any
other legitimate purpose.

This Liability Waiver shall be construed broadly to provide a release and waiver to GameMasters
Limited the maximum extent permissible under Hong Kong law.

I hereby certify that I have read this document and I understand and agree to its content.

Parents Full Name: _________________________

Signature: _________________________

Date: _________________________