• Required Release - Minor

    General Release and Hold Harmless Agreement
  • I, * am the parent or legal guardian of * (the “Minor”), who desires to participate in various programs, events or activities, including but not limited to   *   (hereinafter collectively referred to as the "Activities"), operated or sponsored by Broadview Missionary Baptist Church, an Illinois not-for-profit corporation (the “Church”).

  • I understand and acknowledge that the Church will not allow the Minor to participate in the Activities without releasing and holding the Church, its officers and directors, and its employees, agents, and any parties volunteering on behalf of 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 (including the risk of contracting COVID-19 at the Activities) and fully understand and assume such risks on my behalf and the Minor’s 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, 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 PERSONS VOLUNTEERING ON BEHALF OF THE CHURCH, FROM ALL ACTIONS, CAUSES OF ACTION, INJURIES, CLAIMS, DAMAGES, 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 OF HIS/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, and that the Church may inspect any luggage, bags, purses and other items taken to 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 Activities, which may endanger his or her life, cause disfigurement, physical impairment, or undue discomfort if medical treatment is delayed, and reasonable attempts to contact me and my spouse have been unsuccessful, I hereby appoint Church Staff 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.

  • PHOTOGRAPHY RELEASE

  •  Regarding photographs of myself or my child(ren) taken at the Activities, I give the Church permission to do the following for nonprofit use and without charge:  use at the discretion of the Church, display at an event or be used in a multimedia presentation, reprint and distribute for any Church nonprofit publication with copyright to accompany photo when used (for example, in newsletters, brochures, etc.), display on the Church website, or use quotes and video clips on the Church website and blog. 

  • The undersigned agrees to the above Initialed sections and this Agreement is binding on my heirs, successors and personal representatives. 

  • Powered by Jotform SignClear
  •  / /
  • Powered by Jotform SignClear
  •  / /
  •  
  • Should be Empty: