REDEEM CHURCH Release Form

ASSUMPTION OF RISK, RELEASE AND INDEMNITY AGREEMENT

Your name *

Last name

Email address *

EVENT:

Redeem Youth activities and events for January 1, 2025 through December 31, 2025.

TRIP/ACTIVITY LOCATION:

Varied locations and events to be announced with student and parental notification

DATE(S) & TIMES:

To be determined

DESCRIPTION OF ACTIVITIES:

By signing this liability waiver, you agree to the terms of participation in Redeem Youth trips and activities for the dates listed above. This release of liability waiver applies to student transportation to and from the church or location of event(s) by volunteer leader, parent or Redeem staff. Each activity or event will still require permission by parent for student to attend; however, this signed form serves as the liability release for all activities conducted during the covered date range.

NAME *

CHILD/YOUTH (PARTICIPANT)

PERSONAL INFORMATION:

NAME *

PARENT/LEGAL GUARDIAN

Birthdate *

Address *

HomeWorkOther

Country

Country

Street Address

Apt/unit/box (optional)

City

State

Postal code

EMAIL *

Phone number *

Phone type

MobileHomeWorkOther

ALTERNATE EMERGENCY CONTACT *

NAME

Phone number *

Phone type

MobileHomeWorkOther

MEDICAL INFORMATION:

RELEVANT MEDICAL CONDITIONS, ALLERGIES, ETC. *

NAME OF PEDIATRICIAN/PRIMARY CARE DOCTOR *

Phone number *

Phone type

MobileHomeWorkOther

INSURANCE CO. AND PLAN NAME *

Phone number

Phone type

MobileHomeWorkOther

GROUP NAME/NUMBER *

MEMBER NAME *

MEMBER ID NUMBER *

STUDENT ID NUMBER

In consideration of REDEEM CHURCH (the “Church”) allowing my son or daughter (the “Participant”) to participate in the Activities that are sponsored, hosted by, or otherwise related to the church, I agree as follows:

1. AUTHORITY: I am the parent or legal guardian of the Participant and have authority to enter into this Agreement. I represent that: a) I have authority to enter into this agreement on behalf of anyone else who has legal rights regarding the Participant; or b) everyone else with legal rights regarding the Participant has signed this release.

2. VOLUNTARY PARTICIPATION: I agree that the Participant’s involvement in the Activities is voluntary.

3. PUBLICITY RELEASE: I grant Church permission to record, use, reproduce, and publicly display picture, video, or audio of the Participant’s involvement in the Activities.

4. RISK OF SERIOUS INJURY OR DEATH: I understand that the Activities involve risks that my result in serious injury or death to the Participant. These risks include, but are not limited to , exposure to diseases, wild animals, strenuous physical exertion, drowning, falls or other accidents, and lack of available medical care. I voluntarily assume all such risks.

5. NO DUTY TO ACT ON CONDITIONS SPECIFIC TO PARTICIPANT: I understand and agree that the Church is not qualified to provide medical evaluation or treatment and that the number of participants limits the ability of the Church to provide special care or attention to an individual Participant. Therefore, I understand and agree that the Church has no duty to utilize the information above regarding medical conditions or other limitations faced by the Participant.

6. AITHORIZATION TO ENGAGE MEDICALTREATMENT: I grant permission for the Church to authorize medical treatment for Participant, to call 911 for emergency medical aid, or take other measures to secure medical treatment if, in the Church’s sole and absolute judgement, the Participant becomes ill, sustains an injury, or otherwise requires medical treatment. I give consent to any physician, emergency aid responder, or other health care provider to administer drugs or medicine or to perform such medical treatment as such person determines
necessary for the relief of pain or to preserve the Participant’s life or health. I assume full responsibility for all medical, rescue, transportation, and other expenses incurred on behalf of the Participant and will fully and immediately reimburse the Church for any of these expenses that the Church, in its sole and absolute discretion, chooses to advance.

7. COVERAGE OF MEDICAL EXPENSES: I understand that the Church does not provide insurance for any death, injuries, or medical expenses sustained by the Participant. The Church’s liability insurance (if any) will not provide coverage for death, injuries, or medical expenses because of the operation of this release. Therefore I agree that the Participant has the necessary and appropriate medical, disability, and life insurance coverage to protect the Participant and his or her survivors in the event of injury or death to the participant.

8. RELEASE OF CLAIMS: I release and agree to indemnify the Church (and any co-sponsors, hosts, or related organizations), their officers, directors, employees, agents, and volunteers (collectively, “Released Parties”), from all claims and liabilities of any kind, known or unknown, including, but not limites to, claims based on the negligence of Released Parties (either individually or collectively), related to or arising, directly or indirectly, form my child’s (the Participant’s) participation in the Activities, including travel to and from the Activities. This release is binding on me and my personal representative and heirs. I have carefully read this document and understand what it says.

PARENT/GUARDIAN SIGNATURE *

DATE *

PARENT/GUARDIAN SIGNATURE *

DATE *

Submit

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