Liability Release & Authorization to Consent to Medical Treatment
In the event that a serious accident or illness befalls you, the Van City Church will first make every effort to contact your Emergency Contact. If they cannot be reached, Van City Church is authorized to: Contact the family physician listed above, and follow their instructions. Transport you to a local hospital for treatment by emergency room physician on duty. The undersigned hereby authorized physician named to give consent for any procedure or hospital care deemed advisable by said doctor. In the event that the doctor is not available, Van City Church leadership is authorized to give necessary consent for any treatment, care, diagnosis, and/or examination of the person named.
By submitting this form I hereby release Van City Church, its’ employees and agents from all liability whatsoever for any injury, damage, or loss which may be sustained during the course of involvement with the Van City Church.
Recreational Activity Release
RECREATIONAL ACTIVITY RELEASE OF LIABILITY, WAIVER OF CLAIMS, EXPRESS ASSUMPTION OF RISK AND INDEMNITY AGREEMENT.
Please read and be certain you understand the implications of signing.
Express Assumption of Risk Associated with Recreational Activities.
I, the undersigned do hereby affirm and acknowledge that I have been fully informed of the inherent hazards and risks associated with the recreational activity on the Van City Youth Winter Retreat generally described as VCY Retreat including the rental of equipment and transportation associated therewith in which I am about to engage.
Inherent hazards and risks include but are not limited to:
1. Risk of injury from the activity and equipment utilized is significant including the potential for permanent disability and death.
2. Possible equipment failure and/or malfunction of my own or others’ equipment.
3. This activity takes place outdoors and therefore includes risks associated with exposure to elements, excessive heat, hypothermia, impact of the body upon water, injection of water into my body orifices, encountering objects either natural or man-made, exposure to animals with the attendant risk of kicking, biting, shying away, running off or otherwise moving in an unanticipated manner causing injury and/or death.
4. My own negligence and/or negligence of others, including but not limited to operator error and guide decision making including misjudging terrain, rapids, weather, trails, or route location.
5. Attack by or encounter with insects, reptiles, and/or animals.
6. Accidents or illness occurring in remote places where there are no available medical facilities.
7. Fatigue, chill, and/or dizziness, which may diminish my/our reaction time and increase the risk of accident.
*I understand the description of these risks is not complete and unknown or unanticipated risks may result in injury, illness, or death.
Release of Liability, Waiver of Claims and Indemnity AgreementIn consideration for being permitted to participate in the activity (ies) described above and related activities, I hereby agree, acknowledge and appreciate that:
1. I HEREBY RELEASE AND HOLD HARMLESS WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property, WHETHER CAUSED BY NEGLIGENCE OR OTHERWISE, the following named persons or entities, herein referred to as releases. Van City Church.
2. To release the releasees, their officers, directors, employees, representatives, agents, and volunteers, and vessels from liability and responsibility whatsoever and for any claims or causes of action that I, my estate, heirs, survivors, executors, or assigns may have for personal injury, property damage, or wrongful death arising from the above activities whether caused by active or passive negligence of the releasees or otherwise. By executing this document, I agree to hold the releasees harmless and indemnify them in conjunction with any injury, disability, death, or loss or damage to person or property that may occur as a result of engaging in the above activities.
3. By entering into this Agreement, I am not relying on any oral or written representation or statements made by the releasees, other than what is set forth in this Agreement.
This release shall be binding to the fullest extent permitted by law. If any provision of this release is found to be unenforceable, the remaining terms shall be enforceable.
I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, AND I FULLY UNDERSTAND ITS TERMS, AND UNDERSTAND THAT I HAVE GIVEN UP LEGAL RIGHTS BY SIGNING IT, AND I SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.