Youth Ministry Waivers

Your Name*

First NameMiddle NameLast Name

Address*

Street Address

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Email*

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Participating Child #1 Full Name:*

First NameLast Name

Participating Child #2 Full Name:

First NameLast Name

Participating Child #3 Full Name:

First NameLast Name

Participating Child #4 Full Name:

First NameLast Name

IN CONSIDERATION for being permitted to utilize the recreational facilities of Fresh Impact Church, a Texas corporation not for profit (“FIC”) and/or for my children or wards listed above to so participate for any purpose, including, but not limited to, observation or use of facilities or equipment, attending events, or participation in any recreational or other program on recreational property owned and/or leased by FIC (including without limitation the Fresh Impact Church indoor and outdoor playgrounds, play areas, and/or activities the undersigned, on behalf of himself or herself and such participating children or wards and any personal representatives, heirs, and next of kin (hereinafter referred to as "the undersigned") hereby acknowledges, agrees and represents that he or she has inspected and carefully considered such premises, equipment and facilities and that the undersigned finds and accepts same as being safe and reasonably suited for the use or participation by the undersigned and such participating children or wards.

In addition, the undersigned acknowledges that novel coronavirus (“COVID-19”) infections have been confirmed throughout the United States, including cases in Texas and all other States. In accordance with the most recent guidance and protocols issued by the World Health Organization (WHO), the Centers for Disease Control and Prevention (CDC), (“Public Health Agencies”) for slowing the transmission of COVID-19 (including the Delta Variant thereof and any and all other variants relating thereto), the undersigned hereby agrees, represents, and warrants that neither the undersigned nor such participating child(ren) shall visit or utilize the facilities, services, and programs of FIC if he or she (i) experiences symptoms of COVID-19, including, without limitation, fever, cough or shortness of breath, or (ii) has a suspected or diagnosed/confirmed case of COVID-19. The undersigned agrees to notify FIC immediately if he or she believes that any of the foregoing access/use restrictions may apply to the undersigned and/or such participating child(ren).

FIC has taken certain steps to implement recommended guidance and protocols issued by the Public Health Agencies for slowing the transmission of COVID-19. The undersigned acknowledges and agrees that FIC may revise its procedures at any time based on updated recommended guidance and protocols issued by the Public Health Agencies and further agrees to comply with FIC’s procedures prior to utilizing the recreational facilities and services of FIC. The undersigned further acknowledges and agrees that, due to the nature of the facilities, programs and services offered by FIC, social distancing of 6 feet per person among children and their caregivers in a childcare setting is not possible. The undersigned fully understands and appreciates both the known and potential dangers of utilizing the facilities, programs and services of FIC and acknowledges that use thereof by the undersigned and/or such participating child(ren) may, despite FIC’s reasonable efforts to mitigate such dangers, result in exposure to COVID-19, which could result in quarantine requirements, serious illness, disability, and/or death to the undersigned, such child(ren) and/or persons who are exposed to COVID- 19 as a result of contact with the undersigned and/or such child(ren).

IN FURTHER CONSIDERATION OF BEING PERMITTED TO USE OF FIC’S FACILITIES, PROGRAMS OR EQUIPMENT, THE UNDERSIGNED HEREBY AGREES TO THE FOLLOWING:

THE UNDERSIGNED, ON HIS OR HER BEHALF AND ON BEHALF OF SUCH PARTICIPATING CHILDREN, HEREBY RELEASES, WAIVES, DISCHARGES AND COVENANTS NOT TO SUE FIC, ITS ELDERS, OFFICERS, PASTORS, EMPLOYEES, STAFF, VOLUNTEERS AND AGENTS FROM ALL LIABILITY TO THE UNDERSIGNED OR SUCH PARTICIPATING CHILDREN AND ALL PERSONAL REPRESENTATIVES, ASSIGNS, HEIRS, AND NEXT OF KIN OF THE UNDERSIGNED OR SUCH PARTICIPATING CHILDREN FOR ANY LOSS OR DAMAGE, AND ANY CLAIM OR DEMANDS ON ACCOUNT OF ANY PROPERTY DAMAGE OR ANY INJURY TO, OR AN ILLNESS OR THE DEATH OF, THE UNDERSIGNED OR SUCH PARTICIPATING CHILDREN (OR ANY PERSON WHO MAY CONTRACT COVID-19, DIRECTLY OR INDIRECTLY, FROM THE UNDERSIGNED OR SUCH PARTICIPATING CHILDREN), WHETHER CAUSED BY THE NEGLIGENCE, ACTIVE OR PASSIVE, OF FIC OR OTHERWISE WHILE THE UNDERSIGNED OR SUCH PARTICIPATING CHILDREN ARE IN, UPON, OR ABOUT THE PREMISES OR ANY FACILITIES OR EQUIPMENT THEREIN OR PARTICIPATING IN ANY PROGRAM AFFILIATED WITH FIC.

The undersigned agrees and acknowledges that use of FIC’s facilities, programs and services may involve inherent danger and risk, including, without limitation, the risk of physical illness or injury, death or property damage. THE UNDERSIGNED HEREBY ASSUMES FULL RESPONSIBILITY FOR, AND RISK OF ILLNESS, BODILY INJURY, DEATH OR PROPERTY DAMAGE to the undersigned or such participating children due to negligence, active or passive, or otherwise while in, about or upon the premises of FIC and/or while using the premises or any facilities or equipment thereon or participating in any program affiliated with FIC.

THE UNDERSIGNED further expressly agrees that the foregoing ASSUMPTION OF RISK, AND RELEASE AND WAIVER OF LIABILITY is intended to be as broad and inclusive as is permitted by the laws of the State of Texas and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.

I have read and understand the terms of this Assumption of Risk, Release and Waiver of Liability, and agree to its terms.

Signature*

Date*

Date

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I DO NOT grant Fresh Impact Church permission to use my likeness and my child's likeness in a photograph, video, or other digital media (“photo”) in any and all of its publications, including web-based publications, without payment or other consideration.I hereby grant Fresh Impact Church permission to use my likeness and my child's likeness in a photograph, video, or other digital media (“photo”) in any and all of its publications, including web-based publications, without payment or other consideration.

By granting Fresh Impact Church permission to use my likeness and my child's likeness in a photograph, video, or other digital media (“photo”) in any and all of its publications, including web-based publications, I understand and agree that all photos will become the property of Fresh Impact Church and will not be returned. I hereby irrevocably authorize Fresh Impact Church to edit, alter, copy, exhibit, publish, or distribute these photos for any lawful purpose.

In addition, I waive any right to inspect or approve the finished product wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photo.

I hereby hold harmless, release, & forever discharge Fresh Impact Church from all claims, demands, & causes of action which I or any other persons acting on my behalf or on behalf of my estate may have by reason of this authorization.

I HAVE READ AND UNDERSTAND THE ABOVE PHOTO RELEASE. I AFFIRM THAT I AM AT LEAST 18 YEARS OF AGE, OR, IF I AM UNDER 18 YEARS OF AGE, I HAVE OBTAINED THE REQUIRED CONSENT OF MY PARENTS/ GUARDIANS AS EVIDENCED BY THEIR SIGNATURES BELOW. I ACCEPT:

Signature*

Date*

Date

FRESH IMPACT CHURCH YOUTH MINISTRY WAIVERS

Assumption of Risk, Release and Waiver of Liability

PHOTO/MEDIA RELEASE