Release of Liability By signing this medical consent and liability form, I expressly warrant I am capable
of withstanding both the physical and mental demands of these activities. I also expressly assume all risks of participating in the activities, whether such risks are known or unknown to me at this time. I further release the church and its ministers, leaders, employees, volunteers and agents from any claim that I may have against them as a result of injury or illness, including COVID-19, incurred during the course of participation in these activities. This release of liability is also intended to cover all claims that members of my family or estate, heirs, representatives or assigns may have against the church or its ministers, leaders, employees, volunteers or agents. I further agree to indemnify and hold harmless the church and its ministers, leaders, employees, volunteers, or agents from any and all claims arising from my participation in its activities, programs, and trips or as a result of injury or illness during such activities from August 1, 2020 through July 31, 2021.
Functions & Activities I give my permission to participate in and be photographed in all activities,
programs, and trips sponsored by Smyrna First United Methodist Church from August 1, 2020 through July 31, 2021. Smyrna First United Methodist Church has my permission to use photographs of myself, including but not limited to: publicity, copyright purposes, illustration, advertising, and web content. Prior to my participation, I acknowledge that there are certain risks associated with these activities, including, by way of example, physical injury due to activity-related accidents, and physical injury due to transportation-related accidents, illness or even death. In addition, I acknowledge that there may be other risks inherent in these activities of which I may not be presently aware.
First Aid & Emergency Medical Treatment I recognize that there may be occasions where I may be
in need of first aid or emergency medical treatment as a result of an accident, illness, or other health condition or injury. I consent to any X-ray, examination, anesthetic, medical, surgical or dental diagnosis or treatment, and hospital care, to be rendered under the provisions of the Medical Practice Act on the medical staff of a licensed hospital, whether such diagnosis or treatment is rendered at the office of said physician or at said hospital. In so doing, I agree to pay all fees and costs arising from this action to
I have read the above Medical Consent & Liability Release Form and am fully familiar with the contents thereof. I hereby consent to the Medical Consent and Liability Release Form, including the Release of Liability above and agree that this Medical Consent and Liability Release Form shall be binding upon me and my estate.