Vacation Bible School Registration

Parent/Guardian Information

Emergency Information

Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by {Organization} during the selected camp. In exchange for the acceptance of said child’s candidacy by  {Organization} ., I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless {Organization} . and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected camp sessions.

In case of injury to said child, I hereby waive all claims against  {Organization} . including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all sports activities, including basketball. Some of these injuries include, but are not limited to, the risk of fractures, paralysis, or death.

Medical Release and Authorization

As Parent and/or Guardian of the named athlete, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.

Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named athlete. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me.

Permission is also granted to the  {Organization} . and its affiliates including Directors, Coaches, and Team Parents to provide the needed emergency treatment prior to the child’s admission to the medical facility.

Release authorized on the dates and/or duration of the registered season.

This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.

Consideration:  I acknowledge the personal benefits accruing to me (and my child, as applicable) by reason of participation in The Congregational Church of Manhasset program activities and am aware of the activities in which I, or my child, will be involved through said participation.

Release / Indemnification:  I hereby, in consideration of such benefits and other good and valuable consideration received, consent to the above listed participation and release absolutely, forever discharge, hold harmless and covenant not to sue The Congregational Church of Manhasset, and program location, its directors, employees, agents, volunteers, and affiliates from any and all present or future liability, claims, demands, actions, or rights of action, whether asserted by me or a third party arising out of my (or my child’s) participation in program activities (the “Claims”).  I agree to indemnify and hold harmless The Congregational Church of Manhasset programming for any such Claims brought by me or a third party from any cost associated with defending or litigating such claims, including but not limited to attorney fees, costs, and legal expenses.

Assumption of Risk:  I am aware of the risks associated with participation in The Congregational Church of Manhasset programs and do hereby voluntarily assume full responsibility for any risk or loss, property damage or personal injury, including death, that may result from participation in event activities.  

Medical Emergency:  In the event of injury or medical emergency, I understand that the church’s group leader, not the Congregational Church of Manhasset staff/volunteers, will be responsible for the medical care of all attendees.  It will be the church’s group leader’s responsibility to assess medical needs, obtain and consent to appropriate medical care, transport person in need of medical care and contact parents or guardians of minors.  I release The Congregational Church of Manhasset from any and all liability related to medical treatment.  In addition, I assume the risk and financial responsibility for any injury resulting from the attendee’s participation in all The Congregational Church of Manhasset programming events.

Authorization Addendum – I acknowledge that during my (or my child’s) participation in The Congregational Church of Manhasset programs that certain risks do exist.  These include, but are not limited to, the hazards of being in a construction type setting, travel by automobile, bus and/or public transportation, the risks involved in participating in recreational games and those existing because of consent of these programs.  In consideration of this acknowledgement, I voluntarily have and do hereby, assume all risk associated with my (or my child’s) participation in these programs.

Understanding:  I represent and acknowledge that I have completely read and understand this document and all its terms and all matters referred to herein, and I signed voluntarily as my free act and deed, that I have had ample opportunity to obtain the advice of counsel and that by signing this document, I understand that I am relinquishing legal rights and remedies that may have otherwise been available to me.  I understand that this Waiver and Release shall be constructed as broadly and inclusively as is permitted by applicable law and agree that if any portion of this document is held invalid, the remaining shall continue in full force and effect.  To the extent the restriction on filing lawsuits is deemed unlawful, I agree to submit any Claims to a Christian conciliation/mediation organization for binding resolution.

Media Consent:  I give my consent and permission for the taking of photographs and/or video of me or my child during the described programming, and I waive and/or assign all rights (including copyright) in such media to The Congregational Church of Manhasset.  The Congregational Church of Manhasset, as the sole owners of such media, shall have the exclusive right to control and determine the use, display, performance, reproduction and dissemination of any such photographs and/or videos.

Copy of The Congregational Church of Manhasset Waiver and Release:  It is understood and agreed that a copy of this form shall be treated as authentic and binding as the original and that copy of the same shall be provided to the directors/leaders of any program of The Congregational Church of Manhasset.  

CAUTION:  READ THIS DOCUMENT CAREFULLY BEFORE SIGNING

This is a general release and indemnification of claims

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.