FAITH & BLUE With A Splash of PINK Registration

Partcipate Name*

First NameLast Name
Participate Age*
Other
Parent/Guardian Name

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Email*
example@example.com

Liability Waiver
I am voluntarily participating in the Gaines Avenue COC Youth Activity, which may involve a risk of serious injury. If I am underage, I understand that I should consult with a guardian before participating. By taking part, I acknowledge that these risks are my own or my child's, and that not all risks can be anticipated.

I, for myself and on behalf of my child(ren) or personal representatives, knowingly and voluntarily enter into this Waiver and Release of Liability. By doing so, I waive any rights, claims, or causes of action of any kind that may arise from my participation in the Activity.

I FURTHER AGREE to reimburse, support, and maintain the facility harmless against any claims, damages, compensation, or otherwise brought by the Gaines Avenue COC, and any related costs.

I FURTHER ACKNOWLEDGE that Gaines Avenue COC is not responsible for errors, omissions, acts, or failures to act of any party or entity conducting a specific event or activity on behalf of Releasees. Suppose medical care or treatment is required, I authorize Gaines Avenue COC to provide all emergency medical care deemed necessary, including but not limited to first aid, CPR, emergency medical transport, and sharing of medical information with medical personnel.

I further agree to assume all costs associated with this treatment and to be financially responsible for any expenses incurred as a result thereof. I am aware and understand that I am responsible for maintaining my health insurance. Suppose any damage to equipment, neglect, or recklessness occurs. In that case, I acknowledge and agree to be held liable for any costs associated with any such actions of neglect or recklessness. Both the participant and Gaines Avenue Church of Christ agree that this agreement is clear and transparent as to its terms, and that no other evidence shall be used or admitted altering or explaining the terms of this agreement, but that it will be interpreted based on the language following the purposes for which it is entered into.
AGREE*

Yes

Photo/Video Release
I grant Gaines Avenue COC permission to use my likeness in photographs, videos, or digital media (“photos”) for any of its publications, including online, without payment.

I HAVE READ AND UNDERSTOOD THIS PHOTO RELEASE. I AFFIRM THAT I AM AT LEAST 18 YEARS OLD, OR, IF UNDER 18, I HAVE OBTAINED PARENTAL/GUARDIAN CONSENT AS EVIDENCED BY THEIR SIGNATURES BELOW. I ACCEPT:
AGREE*

YesNo
Date*

MonthDayYear
Date
Signature (If under 18, A PARENT/GUARDIAN MUST SIGN)*

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FOR ANY FURTHER QUESTIONS, PLEASE CONTACT ANTHONY MACKEY AT (229) 669-4437.
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Liability Waiver

Photo/Video Release

FOR ANY FURTHER QUESTIONS, PLEASE CONTACT ANTHONY MACKEY AT (229) 669-4437.