ACC Pine Valley Retreat
MEDICAL RELEASE & LIABILITY RELEASE FORM -
PARENTS’ INFORMATION SHEET
WHAT IS A MEDICAL RELEASE & LIABILITY RELEASE FORM?
The MEDICAL RELEASE & LIABILITY RELEASE FORM serves many purposes, it:
- provides the ACC Pine Valley Retreat camp nurse and staff with your child’s medical history
- releases the ACC Pine Valley Retreat of any liability
- provides a space for you to identify a guardian to be responsible for your child in your absence.
WHY IS A MEDICAL RELEASE & LIABILITY RELEASE FORM REQUIRED?
The San Diego County Health Dept & the Pine Valley Bible Conference Center require it.
WHO IS REQUIRED TO SUBMIT A MEDICAL RELEASE & LIABILITY RELEASE FORM?
Anyone under 18, attending without a parent or legal guardian, must have a parent/legal guardian complete and sign a MEDICAL RELEASE & LIABILITY RELEASE FORM prior to the Retreat. Even if your child is only attending the Retreat part-time or for a few hours, an application and signed MEDICAL RELEASE & LIABILITY RELEASE FORM are required.
HOW DO I APPOINT A GUARDIAN TO BE RESPONSIBLE FOR MY CHILD IN MY ABSENCE?
Anyone under age 18 attending the Retreat without a parent/legal guardian must be assigned a Retreat guardian. Ask an adult family member or friend if they are willing to serve as a guardian for your child. The child’s assigned guardian must be a full-time registered camper that is sleeping on-site. The guardian will make decisions in case of a medical emergency and is responsible for disciplinary issues. Additionally, the appointed guardian is to ensure the minor obeys Retreat rules and attends all mandatory events. Once you find an adult who agrees to serve as a guardian, include their name on the MEDICAL RELEASE & LIABILITY RELEASE FORM and submit the completed form with your child’s application to the Retreat Registrar.
WHERE DO I OBTAIN A MEDICAL RELEASE & LIABILITY RELEASE FORM?
Ask your local church representative or contact the ACC Pine Valley Retreat Registrar,Mary Dragojlovic at 310-374-2411, e-mail or visit for a copy.
WHERE DO I SEND THE MEDICAL RELEASE & LIABILITY RELEASE FORM?
The form must be mailed in with the application to Mary Dragojlovic, ACC Pine Valley Retreat Registrar, 2411-A Vanderbilt Lane, Redondo Beach, CA 90278. Any application received without the MEDICAL RELEASE & LIABILITY RELEASE FORM (for a minor, under age 18, planning to attend the Retreat without a parent/legal guardian)will not be accepted until the form is also received.