Medical Release and Consent Form
We, the undersigned parent(s)or legal guardian(s) of the below named minor HEREBY ASSUME ALL OF THE RISKS OF PARTICIPATING AND/OR VOLUNTEERING IN THIS ACTIVITY OR EVENT, including by way of example and not limitation, any risks that may arise from negligence or carelessness on the part of the persons or entities being released, from dangerous or defective equipment or property owned, maintained, or controlled by them, or because of their possible liability without fault. I certify that my child is physically fit, and have not been advised to not participate by a qualified medical professional. I certify that there are no health-related reasons or problems which preclude my child’s participation in this activity or event. I acknowledge that this Accident Waiver and Release of Liability Form will be used by the event holders, sponsors, and organizers of the activity or event in which my child may participate, and that it will govern my child’s actions and responsibilities at said activity or event. In consideration of my child’s application and permitting them to participate in this event:
(A) I WAIVE, RELEASE, AND DISCHARGE from any and all liability, including but not limited to, liability arising from the negligence or fault of the entities or persons released, for my death, disability, personal injury, property damage, property theft, or actions of any kind which may hereafter occur to me including my traveling to and from this event, THE FOLLOWING ENTITIES OR PERSONS: The New Life Baptist Church and/or their directors, officers, members, volunteers, representatives, and agents, the activity or event holders, activity or event sponsors, activity or event volunteers;
(B) I INDEMNIFY, HOLD HARMLESS, AND PROMISE NOT TO SUE the entities or persons mentioned in this paragraph from any and all liabilities or claims made as a result of participation in this activity or event, whether caused by the negligence of releasee or otherwise. I acknowledge that the New Life Baptist Church and their directors, officers, members, volunteers, representatives, and agents are NOT responsible for the errors, omissions, acts, or failures to act of any party or entity conducting a specific event or activity on behalf of the New Life Baptist Church.
I hereby give permission for my child/dependent to take part in all New Life Baptist Church activities and absolve New Life Baptist Church from liability to me or my child because of any injury received while attending an activity at the New Life Baptist Church. In case of any accident or serious illness, I hereby authorize New Life Baptist Church to call upon a physician of their choice and to follow his instructions. If emergency treatment or hospitalization is required, I request New Life Baptist Church to notify me. I give my consent to the New Life Baptist Church to include picture, video, or other likenesses of myself or my children in promotional materials.
Parent or guardian must sign below. The undersigned parent and natural guardian does hereby represent that he/she is, in fact, acting in such capacity, has consented to his/her child or ward’s participation in the activity or event, and has agreed individually and on behalf of the child or ward, to the terms of the accident waiver and release of liability set forth above. The undersigned parent or guardian further agrees to save and hold harmless and indemnify each and all of the parties referred to above from all liability, loss, cost, claim, or damage whatsoever which may be imposed upon said parties because of any defect in or lack of such capacity to so act and release said parties on behalf of the minor and the parents or legal guardian.
