·About Medical Insurance in the TOP North Carolina
·READ CAREFULLY
MEDICAL/MEDICAL INSURANCE: You can participate in the TOP North Carolina even if you don't have medical/accident insurance, but it will be your responsibility to cover medical expenses in case of an accident. Take note that some Insurance companies can offer coverage for medical/accident expense for specific periods of time, thus you can purchase medical coverage for the dates of the event. Please consult a certified Insurance agent.
I hereby certify the following:
I am the actual participant who will be participating in the TOP, OR I am the Parent or legal guardian of the minor participant.
I am not signing the following forms on behalf of anybody else, unless I am signing the minor participant , for which I am Parent or legal guardian.
I am legally authorized to sign this form.
It is intended that this form comply with the Security Procedures and the statutes under North Carolina Act 40 Uniform Electronic Trasaction Act (2000 - 152 , s.1) and any other State or Federal Law with regards to esignatures.
· LEGENDARIOS/LEGENDARIES – TRACK OUTDOOR OF POTENTIAL
WAIVER, RELEASE OF LIABILITY, INDEMNIFICATION, AND CONSENT TO MEDICAL ATTENTION
1. Voluntary Participation. I understand and confirm that my participation in LEGENDARIOS/LEGENDARIES the presented by LEGENDARIOS NORTH CAROLINA AND MINISTERIOS EMMANUEL (LGNC/ME) is based on my own voluntary will and desire
2. Identification of Risks. I understand that my participation in LEGENDARIOS/LEGENDARIES may involve risk of injury and loss, both to person and to property. I also understand that the risk of injury may include but is not limited to the possibility of temporary or permanent disability and death. I understand that this Waiver, Release of Liability, Indemnification, and Consent to Medical Attention is intended to address all of the risks of any kind associated with my participation in any aspect of LEGENDARIOS/LEGENDARIES, or with the time I am involved in LEGENDARIOS/LEGENDARIES, including, particularly, such risks created by actions, inactions, carelessness, or negligence on the part of LEGENDARIOS/LEGENDARIES or LGNC / ME, and/or its officers, pastors, employees, agents, volunteers, successors, or Assigns (collectively The LGNC / ME "Representatives"), including, but not limited to, risks created by the following:
a. The use and condition of various modes of transportation, premises, facilities, and equipment, to, from and during LEGENDARIOS/LEGENDARIES;
b. The inadequacy or lack of policies, rules, or regulations for LEGENDARIOS/LEGENDARIES;
c. The failure of BLO/CCPP or its Representatives to foresee or to protect me from actions, inactions, or negligence of any person, animal or other natural occurrence, or the recklessness, intentional, or criminal misconduct of persons other than those affiliated with LGNC / ME; The inadequacy or unavailability of medical facilities or treatment; or d. The inadequacy or lack by LGNC / ME or its Representatives.
3. Assumption of Risk. I understand that LEGENDARIOS/LEGENDARIES will be an event of extreme physical challenges, in a natural outdoor environment, with no planned protections from the elements. I assume all risks, known and unknown, foreseeable and unforeseeable, in any way connected with my participation in LEGENDARIOS/LEGENDARIES. I accept personal responsibility for any liability, injury, loss, or damage in any way connected with my participation in LEGENDARIOS/LEGENDARIES. The following is a list of risks however, this list is not intended to be all inclusive:
a. Acts of God and the elements of nature such as climate changes, extreme heat, rain, thunder and lightning, hypothermia, and heat exhaustion;
b. Injuries associated with hiking, kayaking, canoeing and physical activity such as impacts with rocks and trees, physical exhaustion, and drowning;
c. Exposure to wild plants, wild animals and animal bites including Insects, alligators, snakes, bears, wildcats and hogs.
4. Release and Waiver. I release LEGENDARIOS/LEGENDARIES, LGNC/ME and its Representatives from any and all liability for and waive any and all claims for liability, injury, loss, damage, or expense, including attorneys' fees, in any way connected with my participation in LEGENDARIOS/LEGENDARIES, whether or not caused in whole or in part by the negligence or other misconduct of LEGENDARIOS/LEGENDARIES or LGNC/ME or its Representatives (a "Claim").
5. Indemnification. I agree to indemnify and to hold harmless LEGENDARIOS/LEGENDARIES or LGNC/ME and its Representatives from any Claim, or any expense, including attorneys' fees (including the cost of defending any Claim I might make, or that might be made on my behalf, that is released or waived hereby), in any way connected with a Claim.
6. Binding Effect. This instrument shall be binding upon my relatives, personal representatives, heirs, beneficiaries, next of kin, and assigns and shall inure to the benefit of LEGENDARIOS/LEGENDARIES or LGNC/ME and its Representatives.
7. Severability. If any provision (or portion of any provision) of this instrument is held to be invalid or unenforceable, that provision shall be enforceable in part to the fullest extent permitted by law, and such invalidity or unenforceability shall not otherwise affect any other provision of this instrument.
8. Applicable Law. Because LEGENDARIOS/LEGENDARIES shall take place in the State of North Carolina, and in order to provide certainty in the law to be applied in the construction of this instrument, this instrument shall be governed, construed, and enforced in accordance with the law of the State of North Carolina.
9. Marketing Release. LEGENDARIOS/LEGENDARIES or LGNC/ME and its Representatives may record every participant participating in LEGENDARIOS/LEGENDARIES at different times during the LEGENDARIOS/LEGENDARIES event via on videotape, audiotape, or photograph, and may use the applicant’s name, voice, or testimonial without restriction for the future promotional purpose of LEGENDARIOS/LEGENDARIES or LGNC/ME unless stated otherwise in writing.
10. Consent to Medical Treatment. I authorize LEGENDARIOS/LEGENDARIES or LGNC/ME and its Representatives, if present, to provide to me, through medical personnel of their choice, customary medical assistance, transportation, and emergency medical services should I require such assistance, transportation, or services as a result of injury or damage related to my participation in the LEGENDARIOS/LEGENDARIES. This consent is given in advance of any specific diagnosis, treatment, surgery or medications, and is given to provide authorization and specific consent for medical/dental treatment and care on my behalf. This consent does not impose a duty upon LEGENDARIOS/LEGENDARIES or LGNC/ME and its Representatives to provide such assistance, transportation, or services.
11. I certify I have personal health insurance for providing medical services to me, which will provide coverage for me during the duration of LEGENDARIOS/LEGENDARIES. This coverage will insure me FULLY during the duration of said LEGENDARIOS/LEGENDARIES. If I do not have coverage, then I agree to self-insure. If I am traveling internationally, my health insurance includes FULL coverage in the foreign countries where I will travel, with no territorial limitations. I understand that LEGENDARIOS/LEGENDARIES or LGNC/ME and its Representatives provide no health plan and that all medical expenses are my responsibility.
THIS IS A WAIVER, RELEASE OF LIABILITY, INDEMNIFICATION, AND CONSENT. I HAVE READ THIS WAIVER, RELEASE OF LIABILITY, INDEMNIFICATION, AND CONSENT. I UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT. I AM SIGNING THIS WAIVER, RELEASE OF LIABILITY, INDEMNIFICATION, AND CONSENT VOLUNTARILY.