General Release and Hold Harmless Agreement
Heartland Ministry: Heartland Students
Dates of Travel: 06/26/2021
Heartland Trip Leader: Nick Scheske
I am the parent or legal guardian of (the "Minor"), who desires to participate in various programs, events or activities Inside the United States (hereinafter collectively referred to as the "Activities") operated or sponsored by Heartland Church.
I understand and acknowledge that the Church will not allow the minor to participate in the Activities without releasing and holding the Church harmless from any liability arising out of participation in the Activities. I have investigated the risks involved in the Minor's participation in the Activities and fully understand and assume such risks on my behalf. Specifically, I understand and acknowledge that the Minor may suffer or experience, among other things, personal injury or bodily damage, medical disabilities, loss or theft of personal property, imprisonment, abduction and even death.
I REQUEST THAT THE CHURCH ALLOW THE MINOR TO PARTICIPATE IN THE ACTIVITIES, AND IN CONSIDERATION THEREOF AGREE HEREBY TO RELEASE AND FOREVER DISCHARGE THE CHURCH, ITS OFFICERS AND DIRECTORS, AND ITS EMPLOYEES, AGENTS, AND ANY PARTIES VOLUNTEERING ON BEHALF OF THE CHURCH, FROM ALL ACTIONS, CAUSES OF ACTION, INJURIES, CLAIMS, DAMAGES, RANSOM DEMANDS, COSTS OR EXPENSES OF ANY KIND, GROWING OUT OF OR RELATED TO ANY SUCH ACTIVITIES IN WHICH THE MINOR PARTICIPATES. I UNDERSTAND THAT THIS IS A FULL AND COMPLETE RELEASE OF ALL INJURIES AND DAMAGES WHICH I OR THE MINOR MAY SUSTAIN AS A RESULT OR 11S/HER PARTICIPATION IN ANY OF THE ACTIVITIES, REGARDLESS OF THE SPECIFIC CAUSE THEREOF.
I acknowledge and agree that I have given my consent for the Minor to remain in the custody of the Church's representatives while participating in the Activities.
This Agreement is binding on the Minor's Heirs, Successors and Personal Representatives.
MEDICAL TREATMENT AUTHORIZATION AND POWER OF ATTORNEY
In the event the Minor suffers any injury or condition during his or her participation in the Activities, including transportation to and from the Activity, which may endanger his or her life, cause disfigurement, physical impairment, or undue discomfort or medical treatment is delayed, and reasonable attempts to contact me and my spouse have been unsuccessful, I hereby appoint the Heartland Trip Leader as my agent to act for me and in my name (in any way I could act in person) to make any and all decisions for the Minor concerning his or her personal care, medical treatment, hospitalization and health care. This power of attorney and delegation of authority shall terminate when the Agent is first able to contact me or my spouse.
Regarding photographs of the Minor taken at any Heartland Church event, I give Heartland Church permission to do the following for nonprofit use and without charge: use at the discretion of Heartland Church, display at a service or event or be used in a multimedia presentation, reprint and distribute for any Heartland Church nonprofit publication with copyright to accompany photo when used, display on the Heartland Church website, or use quotes and video clips on the Heartland Church website and weekend annuncments.
The undersigned agrees to the above Initialed sections and this agreement is binding on my Heirs, Successors and Personal Representatives.
Today's Date: June 18, 2021