VBS Waiver

Waiver of Liability, Assumption of Risk, Waiver of Claims, Indemnity Agreement and Medical Permission Form (the "Waiver Agreement")

Activity: VBS

In consideration for being allowed to participate in the Activity, I, as the parent or guardian of Participant agree to the following with respect to the Activity:

  • I attest and verify that I will not place Participant in CM unless they are free from all illnesses and medical conditions that could interfere with their or others’ safe participation in the Activity.  

 

  • Waiver of Liability: I will not hold North River Church of Christ, Inc. (“NRCC”) or its officers, directors, employees, leaders, members, volunteers, associates or other agents (collectively, “Agents”) liable for any injury, illness, loss, damage, death or accident that Participant might encounter while participating in the Activity that NRCC is helping to facilitate;

                                                                              

  • Assumption of Risk: I voluntarily and knowingly agree to assume any and all risks that might result from Participant’s participation in the Activity that NRCC is helping to facilitate.  In doing so:
    • I realize that CM involves inherent risks, hazards and dangers that cannot be eliminated regardless of the care taken to avoid them; and
    • I realize that some of these risks include the following:
      • Accidents (such as tripping, bumping a head, or random act from another child), Illness, Injury (such as, scrapes, bumps, bruises, tooth knocked out), Theft, Property Damage, Playground accidents (such as from running, jumping, sliding, or running into a swing), and Acts of God; and
    • I realize that NRCC does not assess or guarantee Participant’s competency, mental or physical fitness, or ability to participate in any project or activity;

 

  • Waiver of Claims: I agree not to sue and to waive and release all claims, to the extent permitted by law, against NRCC or its Agents who lead or direct this activity (including claims related to injury, illness, loss, damage, death or accident);

 

  • Indemnification / Hold Harmless: I agree to fully defend, indemnify and hold NRCC and its Agents harmless from any and all claims, lawsuits, demands, causes of action, liability, loss, damage, and injury of any kind whatsoever (including claims related to injury, illness, loss, damage, death or accident) whether brought by an individual or other entity, or imposed by a court of law or by administrative action of any governmental body or agency, arising out of, in any way whatsoever, any acts, omissions, negligence or willful misconduct on my part or on the part of Participant.

 

Severability: I also agree that this Waiver Agreement is intended to be as broad and inclusive as is permitted by the laws of my state of residence, Participant’s state of residence, the State of Georgia, and US federal law and that if any portion of this Waiver Agreement is held by a court of competent jurisdiction to be invalid, that such provision will be deemed deleted from this Waiver Agreement without invalidating the remaining provisions of this Waiver Agreement or affecting the validity or enforceability of the remaining provisions.

 

Medical Permission: In the event that Participant should need emergency medical or dental treatment and I am unable to provide my permission for such treatment, I hereby:

  • give my permission to the person(s) leading or directing the Activity to use their best judgment in obtaining medical attention/treatment for Participant, including taking Participant to a local medical facility;
  • give my permission to the physician/medical professional that is selected by the person(s) leading or directing the Activity to render medical attention or administer medical treatment as that physician/medical professional deems appropriate and necessary;
  • give my permission to the person(s) leading or directing the Activity to use their best judgment to otherwise render any assistance (ie., first aid, C.P.R., etc.) in the event of Participant’s injury or illness.

 

Medical Costs are my Responsibility: I understand that the NRCC has NOT obtained insurance coverage for medical or hospital costs for Participant and that any costs incurred for injury or illness occurring in the course of the Activity shall NOT be NRCC’s responsibility.

 

Medical Personnel: I understand that the Waiver of Claims and Indemnification / Hold Harmless clauses also apply to those medical professionals assisting with the health needs of the children participating in CM and that no legal action may be taken against them.

 

 

SIGNATURE

 

I, the Parent or Guardian of Participant, certify and declare under penalty of perjury the following:

  • I have received a copy of this document (if desired);
  • I am at least 18 years of age;
  • I am suffering under no legal disabilities;
  • I agree that this Waiver Agreement is binding on Participant as well as on Participant’s parents, guardians, heirs, assigns and executors or personal representatives; and
  • I have read the above Waiver Agreement carefully before signing.

 

I am authorized to sign on behalf of the Participant and I am signing this Waiver Agreement both on behalf of and in the place of the Participant.  I agree to all the conditions of and permissions conferred by this Waiver Agreement as parent or guardian (including the certifications and declarations in this Signature section), and also as if I were the Participant.