Individual Event Permission And General Release Of Claims

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FORM G
Participants Name:_____________________________
Permission and General Release of Claims
Individual Event Form
Event Date: _ _ /_ _ /_ _ _ _
Event Name: ______________________________
PARENT/LEGAL GUARDIAN PERMISSION
In consideration of being accepted for participation in all Harvest Baptist Church of Oswego a/k/a Harvest, A Place of
New Beginnings (“Harvest”) sponsored youth/children activities, I give my permission for my youth/child to participate in:
________________________________________________ activities, including both on-site and off-site activities and any
related transportation, food or lodging.
RELEASE AND WAIVER
PLEASE READ THIS FORM CAREFULLY. Be aware that by participating in the church sponsored youth/child activities, including any
related transportation, food or lodging and using the facilities and equipment, you will be releasing and waiving all claims for death,
personal injury, medical expense, damage, property damage, or loss that you and each participant, including your youth/child, might
sustain arising in any manner during these activities including any related transportation, food or lodging or the use of the facilities or
equipment. This form must be completed and signed by a parent/legal guardian of each youth/child participant or they will not be
allowed to participate or use the facilities or equipment.
ACKNOWLEDGEMENT OF RISK OR INJURY CLAUSE - I recognize and acknowledge that there are risks of physical injuries, including
personal injury, sickness, death, medical expense, damage, property damage, or loss which the participant or their parent(s)/legal
guardian(s) may sustain as a result of participating in any and all activities, including any related transportation, food or lodging or the
use of the facilities or equipment of Harvest.
RELEASE AND WAIVER OF CLAIM FOR INJURY CLAUSE – I, for myself and for my youth/child, do hereby fully release and discharge all
claims that I and my youth/child may have for injuries or damages against Harvest and its officers, agents, servants, employees, and
affiliates as a result of participating in church sponsored youth/child activities, including any related transportation, food or lodging or
using the facilities or equipment, and further agree to waive and relinquish any and all such claims. I hereby assume all risk of
personal injury, sickness, death, medical expense, damage, loss and other expense which may be sustained by the recipient or their
parent(s)/legal guardian(s) as a result of participation of my youth/child in church sponsored youth/child activities including any
related transportation, food or lodging or using the facilities or equipment of Harvest.
INDEMNITY AND DEFENSE CLAUSE - I further agree to indemnify and hold harmless and pay defense costs and defend the Harvest
Baptist Church of Oswego and its officers, agents, servants, employees, and affiliates, from any and all claims resulting from injuries,
including personal injury, sickness, death, medical expense, damage, property damage, or loss sustained by me or my youth/child and
arising out of, connected with, or in any way associated with church sponsored youth/child activities including any related
transportation, food or lodging or using the facilities or equipment.
MEDICAL CARE – In giving the permission to participate in church sponsored youth/child activities including any related
transportation, food or lodging, or using the facilities or equipment of Harvest, I hereby give permission and authorization for medical
treatment, including but not limited to emergency surgery, and assume the responsibility for all medical bills, if any. I understand
that, subject to the participant’s interests and their medical condition, attempts will be made to alert the parent/legal guardian before
any such necessary medical treatment is given.
I have read and fully understand the above document and have had any questions I may have concerning it fully answered. I freely
agree to its terms and conditions on behalf of myself and my child/youth. I affirm that the information below is accurate and current.
I further affirm that I have the authority to sign this Permission and General Release of Claims on behalf of the youth/child participant
and their parent(s)/legal guardian(s).
Print name of participant:___________________________________________________Birthdate:____________________
Parent/Legal Guardian Signature:____________________________________________ Date:_______________________
Print name of Parent/Legal Guardian:_____________________________________________________________________
Attorney Reviewed PD 4/15/2014
(continued on back)
R:/Administration/Forms Library/Permission & Release Forms/Individual Event Permission and General Release of Claims 2014

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