I (We) acknowledge that participation in the Prairie Lakes Church Trip is voluntary and may require involvement in activities that require traveling or physical exertion. I (We) acknowledge that participation in the trips activities presents risks that the attendee may suffer property damage, bodily injury, or death. Therefore, in consideration of the attendee being allowed to participate in the Prairie Lakes Church trip program activities, I (we) agree to the following:
Prairie Lakes Church is not responsible for the loss or theft of personal belongings.
Misconduct may result in transportation home from an activity at the attendee or parents’ expense. Being dismissed for a disciplinary reason will not receive a refund.
I understand and authorize permission in the event the attendee may be photographed or filmed and used in video presentations, printed publications of Prairie Lakes Church Ministries including the Internet website. Please note names of minors will not be used in these publications.
I hereby take the following action for my/our child, myself, my executors, administrators, heir, next of kin, successors and assigns: A) I /we waive, release, and discharge from any and all claims or liabilities for death or personal injury the following person, or entitles: Prairie Lakes Church, it’s Senior Pastor and Associate Pastors, Elders, Employees, volunteers, representatives, subcontractors and agents of any of the above: B) I/we agree not to sue any of the persons or entities mentioned above for any of the claims or liabilities that I/we have waived, released or discharged herein except in the case of gross negligence on the part of Prairie Lakes Church, Prairie Lakes Church staff or volunteers and: C) I/we indemnify and hold harmless the person or entities mentioned above from any claims made or liabilities assessed against them as a result of my own or my/our child’s actions. I/we hereby assume the risks of the attendee participating in the trip with Prairie Lakes Church.
For minors only:
The undersigned parent/guardian, the parent and natural guardian or legal guardian of ___________________ (minor’s name) hereby executes this document for and on behalf of the minor named herein. I agree to indemnify and hold harmless the person or entities mentioned above for any claims or liabilities assessed against them as a result of any insufficiency of my legal capacity or authority to act for and on behalf of the minor in the execution of the Waiver and Release.
I hereby authorize any licensed physician, emergency, medical technician, hospital or other medical or health care facility to treat the minor named herein for the purpose of attempting to treat or relieve any injury received by said minor. I authorize any such medical provider to perform all procedures deemed medically advisable in attempting to treat or relieve such injuries. I consent to the administration of anesthesia as deemed advisable. I realize and appreciate that there is a possibility of complications and unforeseen consequences in any medical treatment, and I assume any such risk for and on behalf of myself and said minor. I understand that attempts will be made to contact me in the most expeditious manner possible. Permission is also granted to Prairie Lakes Church representatives to provide the needed emergency treatment to the said child prior to their admission to a medical facility.