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Minor Release Form

 

 AUTHORIZATION, CONSENT AND RELEASE FOR MINOR

 

I, ____________________________________ , an individual, or as parent or legal guardian of ____________________________________

 

DOB: _____/_____/_______ state my desire to participate (or for my child to participate) in certain activities being offered by or through

Celebration Church, the corporate structure, its officers, directors, employees, agents, contractors, and volunteers (collectively referred to as the ”Church”) and in consideration for being allowed to participate state and agree as follows:

 

I warrant that I possess all the rights, powers, and privileges on behalf of myself or as a parent or legal guardian necessary to execute this document with binding legal effect.

 

I certify and affirm that I have been completely and thoroughly informed that by attending the activities of the Church, I (my child) will participate in certain activities which carry with them a degree of risk and danger.

 

Examples of risky and dangerous activities include, but are not limited to:

 

1. physical activities, both indoors and outdoors;

2. sports, both informal and organized;

3. use of recreational equipment;

4. field trips;

5. travel by automobile;

6. activities around water, including swimming and boating;

7. hiking;

8. camping; and,

9. motocross and motor cycle riding.

 

I acknowledge and understand that the Church may offer other activities not listed above that present similar risks or dangers to me (my child). I understand that these activities, listed and not listed, may be undertaken on or off Church property. I understand that injuries resulting from participation in these activities, listed and not listed, could range from minor aches, bruises and cuts, illness or disease, physical or mental damage and to serious, permanent and disabling injuries, and even in death.

 

I consent to my (my child's) participation in these activities. I acknowledge and understand that this AUTHORIZATION, CONSENT AND RELEASE has the same force and effect regardless of whether the activities engaged in are free or if a fee is charged.

Further, I personally assume, on my (my child's) behalf, all risk in connection with said activities for any harm, injury or damages that may befall me (my child) as a result of participation in the activities, whether foreseen or unforeseen, and I still wish to proceed (allow my child to proceed) with the activities. As a matter of fact, I am familiar with the nature, degree, and type of risks associated with these activities and do not need them explained to me.

 

In consideration of me (my child) being allowed to participate in these activities and to use the Church’s equipment, facilities, staff or volunteers or hired contractors, on behalf of my child, I hereby voluntarily release, forever discharge, and agree to indemnify and hold harmless the Church, including the corporate structure, officers, directors, employees, agents, contractors, and volunteers, from any and all claims, demands, or causes of action, which are in any way connected with my (my child’s) participation in these activities or use of the Church’s or site event’s equipment, facilities or personnel, __________________________________ , an individual, or as parent or legal guardian of ______________________________.

IN CASES OF EMERGENCY, I further consent to the examination or treatment of my child by a physician duly licensed to practice medicine in the jurisdiction where the emergency occurs or any health care professional duly licensed to provide health care services in the state where the emergency occurs for medical care and services deemed necessary by the Church, its agents, servants, and employees.

I understand and agree that the Church is not under a legal duty or requirement to render aid or medical treatment but will use its best judgment as to when to render aid or summon medical care.

 

I give permission to the doctor or health care professional to provide any and all medical care they deem, in their professional opinion, to be necessary to maintain the health, safety, and life of me (my child).

 

I agree to pay for any and all medical expenses incurred as a result of the use of this consent.

 

I understand that it is my obligation to inform an authorized representative of the Church of any and all health considerations or medical conditions that would restrict my (my child’s) participation in any and all activities while engaged in the activities. I (my child) shall not participate in the activities if I (my child) am/is not presently healthy or alert enough to, in my judgment, do so.

Should the need for medical attention arise for my child and I am not present, the Church will attempt to contact me as soon as practicable under the circumstances.

 

While engaged in these activities, I further AUTHORIZE THE CHURCH TO TAKE PHOTOS OR VIDEOS capturing my (my child’s) name, voice, and likeness and to use such materials for such purposes as the Church deems useful for its purposes.

By signing this document, I acknowledge that if anyone is hurt or property is damaged during my (my child’s) participation in these activities, I may be found by a court of law to have waived my right to maintain a lawsuit against the Church on the basis of any claim from which I have released them herein.

 

I agree that if any portion of this agreement is found to be void or unenforceable, the remaining portions shall remain in full force and effect.

The Participant hereby acknowledges and agrees that the Participant has carefully read this Waiver, that the Participant fully understands the same, and that the Participant is freely and voluntarily executing the same.

The Participant understands that by signing this Waiver, the Participant agrees to be forever prevented from suing or otherwise claiming against the Activity Provider for any property loss or personal injury that the Participant may sustain while participating in or preparing for the above noted activity.

Governing Law

This Waiver will be construed in accordance with and governed by the laws of the State of Florida.

 

I have fully informed myself of the contents of this AUTHORIZATION, CONSENT AND RELEASE by reading it before I signed it.

 

 

First Minor Volunteers Name

First Name*

Middle Name

Last Name*

Phone*
First Minor Volunteers Date of Birth*
I certify that I am 18 years of age or older
First Minor Volunteers Signature*
Second Minor Volunteers Name

First Name*

Middle Name

Last Name*
Second Minor Volunteers Date of Birth*
Third Minor Volunteers Name

First Name*

Middle Name

Last Name*
Third Minor Volunteers Date of Birth*
Fourth Minor Volunteers Name

First Name*

Middle Name

Last Name*
Fourth Minor Volunteers Date of Birth*
Fifth Minor Volunteers Name

First Name*

Middle Name

Last Name*
Fifth Minor Volunteers Date of Birth*
Sixth Minor Volunteers Name

First Name*

Middle Name

Last Name*
Sixth Minor Volunteers Date of Birth*
Seventh Minor Volunteers Name

First Name*

Middle Name

Last Name*
Seventh Minor Volunteers Date of Birth*
Eighth Minor Volunteers Name

First Name*

Middle Name

Last Name*
Eighth Minor Volunteers Date of Birth*
Ninth Minor Volunteers Name

First Name*

Middle Name

Last Name*
Ninth Minor Volunteers Date of Birth*
Tenth Minor Volunteers Name

First Name*

Middle Name

Last Name*
Tenth Minor Volunteers Date of Birth*
Minor Volunteers Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email
Check to receive information, news, and discounts by e-mail.
A signed copy of this waiver will be sent to the email address you provide.
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Phone*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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