In consideration of my being accepted by Undivided Heart, Inc. for visitation to Gold Monarch Healing Center as set forth below I affirm and acknowledge the following:
I affirm that I am 18 years of age or older OR
I am the natural parent or legal custodian of minor listed below,
and am vested with legal authority to waive and release liability as set forth herein: I acknowledge the dangers and risks include, but are not limited to, the hazards of travel by air, motor vehicle or on foot; sickness or injury; exposure to forces of nature, poisonous reptiles/insects or other dangers. I understand that the above and other possibilities are potential risks of attendance at Gold Monarch Healing Center (Undivided Heart, Inc.) or any of its activities that may include ministry.
I know and understand that Undivided Heart, Inc., Gold Monarch Healing Center, David Black, Amy Black, and Undivided Heart, Inc. individual leaders and staff members do not accept any responsibility for injury, illness or loss suffered by me (or the above referenced minor) and that all medical or personal expenses in connection with or made necessary by my illness or injury on this trip are my own responsibility.
I acknowledge that Undivided Heart, Inc. does not accept any responsibility for any injury, loss or damage, whether or not covered by any insurance. I further acknowledge that Undivided Heart, Inc. has required that I carry or obtain primary medical insurance covering personal injury, emergency evacuation and/or possible medical needs occurring during this trip. I hereby assume all risk of personal injury, sickness, or death, and damage to or loss of personal property, and any delay, change of travel arrangements, and any and all other damage or expenses I may suffer as a result of participation in the Gold Monarch Healing Center or any of its activities. I agree to be fully responsible for my actions. Should I become ill or injured or suffer other damage, I will pay all costs involved including costs of evacuation and medical care I might receive. I hereby voluntarily release forever, discharge and agree to hold harmless and indemnify, including costs of litigation, Undivided Heart, Inc., its directors, officers, agents, employees, coordinators, facilitators, volunteers, and other team members from any and all liability, claims, demands, actions or rights of actions which arise out of, or are in any way connected with my participation in this activity.
I authorize Undivided Heart, Inc. to arrange for transportation, food, and lodging on this trip. Before executing this Agreement I have made my own independent inquiry into all the facts and issues involved in this event and those raised by this document. With regard to my personal safety and well-being, I am not relying on any comment, statement, promise or other communication from or on behalf of Undivided Heart, Inc., other than what is set forth herein. I agree that the State of Texas shall be the jurisdiction where any legal action concerning the subject matter of this Release shall be conducted. This Agreement shall be governed by the laws of the State of Texas.
I hereby make each of the above statements, acknowledgements, authorizations, releases, discharges, hold harmless agreements, indemnities and other agreements which shall be binding on my heirs, successors and assigns. I agree that these promises, agreements, assumptions of risk and releases bind me, my family, and all minors with me or on whose behalf I sign, and my heirs or legal representatives and assigns.
If signing on behalf of a minor, I hereby affirm that I have the legal authority to make this release and waiver and do so freely and voluntarily with full knowledge of the facts and circumstances.
COVID-19: I hereby release Gold Monarch from any liability regarding exposure to COVID-19.