Emmaus Baptist Church Release of Liability, Waiver, and Indemnity Agreement

This release will remain in effect for one year from the date signed below.

Name of Child: *

I hereby give my permission for my child to participate in any/all ebcKids or Youth program of Emmaus Baptist Church, Inc on and off Emmaus Baptist Church property. *

I have read and agree to the above terms.

For and in consideration of permitting my child/youth (named above) to observe, or use any facility or equipment of Emmaus Baptist Church, INC, or engage in and/or receive instruction in any activity or activity incidental thereto SOME OF WHICH MAY INVOLVE DANGERS AND RISK OF BODILY INJURY, I, the undersigned parent or guardian, hereby voluntarily and absolutely release, discharge, waive, and relinquish any and all loss or damages or actions or causes of action for personal injury, property damage, or wrongful death occurring to my child as a result of my child’s observing or using facilities or equipment of Emmaus Baptist Church, INC, or engaging in or receiving instructions in any activities SOME OF WHICH MAY INVOLVE DANGERS AND RISK OF BODILY INJURY or in activities incidental thereto wherever or however the same may occur, and for whatever period said activities or instructions may continue. *

I have read and agree to the above terms.

I, the undersigned parent or guardian of my child (named above), his/her heirs, executors, administrators, or assigns agrees that in the event any claim for personal injury, property damage, or wrongful death shall be prosecuted against Emmaus Baptist Church, INC, or its officers, board of directors, agents, servants, or employees, the undersigned parent or guardian will indemnify and hold harmless Emmaus Baptist Church, INC and its officers, board of directors, agents, servants, or employees from any and all claims or causes of action by my child or by any other person or entity, by whomever or wherever made or presented, and under no circumstances will the undersigned parent or guardian of my child (named above) present any claim against Emmaus Baptist Church, INC and said persons for personal injuries, property damage, wrongful death, or otherwise, caused by any act of negligence by Emmaus Baptist Church, Inc and said persons. *

I have read and agree to the above terms.

Further, in the event that I cannot be reached by telephone, I do authorize the Emmaus Baptist Church staff/sponsors/volunteers to give consent to a physician and/or hospital for emergency medical or surgical treatment. It is understood that I will assume any financial responsibility for any expense that may be incurred for said emergency treatment. Further, I do certify that said child is covered under adequate accident insurance. My consent and signature is given below. *

I have read and agree to the above terms.

I, the undersigned parent or guardian represent that I have read this Release, have requested and have been provided with, or have requested and declined advisement on the potential dangers/risks of engaging in the observation, activities, or instruction offered, assumes all risks associated with such dangers and risks, and is fully aware of and understands the terms and the legal consequences of the signing of this Release. I, the undersigned parent or legal guardian intends my signature to be a complete and unconditional release of all liability to the greatest extent allowed by law and if any portion of the Release is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. *

I have read and agree to the above terms.

I, the legal parent/guardian of (named above), hereby authorize and consent to the use of images or videos of my child/children listed above, with or without their name(s), by Emmaus Baptist Church, INC of Poquoson, Virginia for purposes including but not limited to: promotional materials, printed publications, internet posts including social media, television, and other media sources. I do this with full knowledge and consent and waive all claims for compensation for use or for damages. I release Emmaus Baptist Church, INC, its officers, board of directors, employees, and agents from liability for any claims by me or any third party in connection with the use of the image of my child/children listed above. *

I have read and agree to the above terms.

SIGNATURE OF PARENT OR GUARDIAN *

DATE: *

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