EVENT: 2023 Annual Meeting & Missions Celebration

NOTE TO PARTICIPANT: All Adult (18+) KentuckyWMU Event participants must complete this form. All sections must be completed for eligibility. The form must be submitted to Kentucky WMU before the participant can participate in programming.

AUTHORIZATION FOR TREATMENT/ RELEASE OF ALL CLAIMS

if I, the undersigned, do for myself give my permission for an attending physician or hospital to administer medical care deemed necessary by the KentuckyWMU Event/Project Coordinator and the physician or hospital staff during the KentuckyWMU event/ project. I, the undersigned, do for myself give my permission to KentuckyWMU volunteer medical professionals to administer any non-prescription medications deemed necessary during the KentuckyWMU Event/ project. I, the undersigned, do for myself, my heirs, executors, administrators, successors and assigns understand that secondary medical coverage in the amount of $2,500 (maximum) is provided for each KentuckyWMÜ participant and do hereby release from all claims and forever hold harmless the directors, officers, agents and employees of Kentucky Changers, Kentucky Woman's Missionary Union, Kentucky Baptist Convention, and all partners(the venue, church, ministry, city, county, or school) from any and all claims and demands for personal injury, sickness, and death, as well asproperty damage and expenses, of any nature incurred by myself including claims and demands arising from criminal acts of other persons. I also assume personal responsibility for all medical bills in excess of the applicable medical insurance plan provided by KentuckyWMU. Further, should it be necessary that I be returned home due to disciplinary action, medical reasons, or otherwise, I hereby assume responsibility for all transportation costs.

PARTICIPANT MODEL RELEASE

By signing this document the participant hereby gives the Kentucky Woman's Missionary Union, its licensees, successors, legal representatives, and assigns the absolute and irrevocable right and permission to use the participant's name and to use, reproduce, edit, exhibit, project, display, copyright, publish photographic images and/or moving pictures, and/or videotaped images of the participant with or without the participant's voice, or in which the participant may be included in whole or in part photographed, taped, videotaped, and/or recorded during the duration of the project, and therefore to circulate the same in all forms and media for art, advertising, trade, competition, of any description and/or any other lawful purpose and/or approve the finished product or products or the editorial, promotional or printed copy or soundtrack that may be used in connection therewith and any right that I may have to control the use to which said product, products, copy, and/or soundtrack may be applied. The participant discharges and agrees to save harmless the Kentucky Woman's Missionary Union, its licensees, successors, legal representatives, and assignees, Kentucky Woman's Missionary Union and the partners from any liability by virtue of any blurring distortion, alteration, optical itlusion, or use in composite form whether intentional or otherwise, that may occur or to be produced in the making, processing, duplication, projecting, or displaying of said images, and from liability for violation of any personal or proprietary right that I may have in connection with said images and with the use thereof.

I agree to all statements above