Authorization. I am the Parent or Legal Guardian of the Minor Child. I do hereby voluntarily give my permission for the Minor Child to participate in the Lincoln Berean Church Youth Group ("Group") for off-site activities for the time period from August 1, 2017 to July 31, 2018. This authorization will apply on all occasions that the Minor Child participates in a Group off-site activity during the above time-period.
I understand the specific off-site activities in which the below-named student may participate may be inherently dangerous and may include, but are not necessarily limited to, the following: retreats, recreational activities, sporting activities, swimming activities and missions work.
Acknowledgment of Risks. I understand that travel to and participation in Group off-site activities by the Minor Child involves inherent risks even when reasonable safety measures are taken and it is not possible to guarantee Minor Child's safety. These risks include, but are not limited to, motor vehicle accidents, exposure to the elements present in outdoor environments, psychological injury, muscle strains, broken bones, head injury, back injury and other personal injuries. I have familiarized myself with these risks and understand these risks may be severe in nature and on rare occasions may even result in total disability, paralysis or death. I voluntarily assume all such risks on behalf of myself and the Minor Child.
Release, Waiver and Indemnification. In consideration of the Minor Child being allowed to participate in the Group off-site activities, I hereby release Lincoln Berean Church and its governing board, officers, agents, volunteers, sponsors and employees (collectively, "LBC Parties") from all actions, causes of action, damages, claims or demands that I, the Minor Child or our respective heirs, executors, administrators or assigns may have against any of the LBC Parties for all damages and injuries which I or the Minor Child may incur by traveling to and from and participating in the Group off-site activities, including, but not limited to, those outlined above under Acknowledgment of Risks, whether such injuries are caused by my negligence, the Minor Child's negligence, or the negligence of one or more of the LBC Parties. I agree to indemnify and hold harmless the LBC Parties and pay for any costs, attorney fees or awards that may result from defending any complaint or lawsuit which the Minor Child may bring against the LBC Parties for any injury the Minor Child claims to have suffered in connection with the transportation to and participation in any Group off-site activity.
Medical Treatment Authorization. I understand that I will be notified in the case of a medical emergency pertaining to my child. In the event that I cannot be reached, however, I authorize the calling of a physician and the providing of any necessary medical services in the event that my child is injured or becomes ill. In these situations, I consent to and authorize an adult leader or chaperone of the Group to consent to all necessary and appropriate x-ray examinations, anesthetic, medical or surgical diagnosis or treatment and hospital care. I understand that the LBC Parties will not be responsible for medical expenses incurred solely on the basis of this authorization. I also understand that the designated adult activity leader or chaperone shall have the right to restrict the Minor Child from any activity that he or she does not believe is within the Minor Child's physical capabilities.
Expenses and Damages. I assume responsibility for, and agree to indemnify the LBC Parties from, any and all expenses incurred and damages caused by the Minor Child while traveling to and participating in the Group off-site activities.
Photographs and Videos. I consent to the Minor Child being photographed, audio recorded or video recorded while participating in Group off-site activities which may be used in brochures, on church/Group social media, church/Group website, as well as audiovisual productions for church/Group events, and waive any privacy rights in the display of such photographs or recordings or any claims of ownership.
Disputes. Any disputes shall be governed by Nebraska law and venued in Lancaster County, Nebraska.
Agreement to Use Electronic Means. I have agreed to submit this Authorization, Waiver and Release on behalf of the Minor Child by electronic means. By submitting this Authorization, Waiver and Release electronically, I certify that I have read this Authorization, Waiver and Release and understand all of its terms. I execute it voluntarily and with full knowledge of its significance and understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature. I understand that it contains a release of liability and indemnification obligations.
I Agree By checking this box and signing my name below, I am electronically signing the Authorization, Waiver and Release.
July 20, 2018