GracePoint Youth - Waiver and Liability Form

 

Participation Agreement

I acknowledge that participating in the programs and other activities of GracePoint involves risk to the participant (and to the participant’s parents or guardians if the participant is a minor), and may result in various types of injury including, but not limited to, the following: sickness, exposure to infectious/communicable disease, bodily injury, death, emotional injury, personal injury, property damage, and financial damage. In addition, I acknowledge that there may be other risks inherent in these activities of which I may not be presently aware. Further, the participant (or parent/guardian) releases and promises to indemnify, defend, and hold harmless the activity sponsor for any injury arising directly or indirectly out of the described activity or transportation to and from the activity, whether such injury arises out of the negligence of the activity sponsor, the participant, or otherwise.

 

Release of Liability

By signing this Permission/Waiver Form, I expressly warrant that the child named above is capable of withstanding both the physical and mental demands of the activities discussed above. I also expressly assume all risks of the child participating in the activities, whether such risks are known or unknown to me at this time. I further release GracePoint and its leaders, employees, volunteers, host families, and agents from any claim that my child may have or that I may have against them as a result of injury or illness incurred during the course of participation in the activities. This release of liability shall include (without limitation) any claims of negligence or breach of warranty. This release of liability is also intended to cover all claims that members of the child's or my family or estate, heirs, representatives, or assigns may have against GracePoint or its leaders, employees, volunteers, or agents. I further agree to indemnify and hold harmless GracePoint and its leaders, employees, volunteers, or agents from any and all claims arising from my participation in its activities and programs, or as a result of injury or illness of my child during such activities. 

If a dispute over this agreement or any claim for damages arises, the participant (or parent/guardian) agrees to resolve the matter through a mutually acceptable alternative dispute resolution process. If the participant (or parent/guardian) and the activity sponsor cannot agree upon such a process, the dispute will be submitted to a three-member arbitration panel for resolution in accordance with the rules of the American Arbitration Association.

 

First Aid and Emergency Medical Treatment 

I recognize that there may be occasions where the child named above 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 do hereby give permission for agents of GracePoint to seek and secure any needed medical attention or treatment for the child named above, including hospitalization, if in the agent's opinion, such need arises.

Furthermore, I give authorize any GracePoint staff, volunteer, or chaperone, in whose care the minor has been entrusted, to consent to any x-ray examination, anesthetic, medical, surgical, or dental diagnosis or treatment, and hospital care, to be rendered to the minor due to the general or special supervision and on the advice of any physician or dentist, whether such diagnosis or treatment is rendered at the office of said physician or at said hospital. The undersigned shall be liable and agree(s) to pay all costs and expenses incurred in connection with such medical and dental services rendered to the aforementioned child pursuant to this authorization. Should it be necessary for our (my child) to return home due to medical reasons or otherwise, the undersigned shall assume all transportation costs.

 

Permission to Ride in Vehicle

The undersigned does also hereby give permission for my child to ride in any vehicle designated by the adult in whose care the minor has be entrusted while attending and participating in events sponsored by GracePoint.

 

Other Permissions

The undersigned does also hereby give permission for photo and video of my child to be posted to ilovegracepoint.com, GracePoint Youth’s Facebook page, or related social media accounts. Any photographs or videos will only be used to promote GracePoint, and be used by GracePoint staff and/or leaders.

By signing below, I claim that I am the parent/guardian of the student listed at the top of this form, who is under 18 years of age. I have read the above Permission/Waiver Form and am fully familiar with the contents thereof. I give permission for the child named above to participate in the activities of GracePoint, including any special events/activities described above. In consideration for allowing the participation of the child in the activities of GracePoint, I hereby consent to the Permission/Waiver Form, including the Release of Liability above, on behalf of the child, and agree that this Permission/Waiver Form shall be binding upon me, my family, heirs, legal representatives, successors, and assigns.