Rising 6th Graders

ASSUMPTION OF RISK, WAIVER, RELEASE AND HOLD HARMLESS AGREEMENT ("RELEASE")

A COMPLETED FORM MUST BE ON FILE BEFORE YOUR CHILD CAN PARTICIPATE IN THE OFFSITE ACTIVITIES

I am the parent, legal guardian or custodian of the above named participant, minor child ("child"), and I hereby acknowledge that my child will participate in Berean Christian Church Malibu Grand Prix (hereinafter BCC Malibu), to Malibu Grand Prix. Travel to/from the BCC Malibu is scheduled to depart Saturday, July 29, 2017 at 11:30am and return at or about 4:00pm. I understand this activity involves highway travel to Malibu Grand Prix, 5400 Brook hollow Pkwy Norcross Ga 30071. I understand and acknowledge that Berean Christian Church, Inc. (“Berean”) is the legal entity that will provide and operate the vehicle(s) for this activity.

As a condition and in consideration of allowing my child’s participation in the BCC Malibu and/or programs, I, the undersigned parent or guardian, hereby give permission for my child to travel to, attend and participate in the BCC Malibu. Also, on my behalf and my child’s behalf, I have signed this ASSUMPTION OF RISK, WAIVER, RELEASE AND HOLD HARMLESS AGREEMENT form (“Release”) in the space provided below indicating my acknowledgment, understanding, and agreement with the following:

1. I certify that, in advance of my child’s participation in the BCC Malibu, I am making an informed choice regarding my child’s participation in the BCC Malibu which may include, but not limited to, transportation to and from New Beginning Baptist Church. I understand the departure and return site is Berean Christian Church, 2201 Young Road, Stone Mountain, GA 30088. I understand Berean staff and/or adult volunteers shall accompany my child while traveling (to and from) and during the BCC Malibu
2. ASSUMPTION OF RISKS: I acknowledge, understand and agree that voluntary participation in the BCC Malibu involve inherent risks, both known and unknown. These risks and dangers may be caused by the negligence of the participant or the negligence of others. Further, I understand and agree that it is impossible to eliminate all risk involved in road and or highway travel and many other factors outside the control of Berean. The risk may range in severity from minor to serious and could include even death. With my understanding of these risks, I hereby voluntarily agree to ASSUME ALL RISKS associated with my child’s participation in such BCC Malibu, including, merely observing an activity and travel to and from this event
3. RELEASE, WAIVER, INDEMNIFY and HOLD HARMLESS: I, for myself, my heirs, personal representatives or assigns, do hereby knowingly, freely and voluntarily, agree to RELEASE, WAIVE, COVENANT NOT TO SUE, and DISCHARGE Berean Christian Church, Inc., its pastors, directors, officers, employees, volunteers, agents, guests, invitees, or affiliate entities (collectively hereinafter “Berean”) from any and all liability, claims, causes of action, suits, including negligence resulting in personal injury, accidents, or illness (including death), and property damage, or expenses, loss of services, compensations, judgements, demands or loss arising from, but not limited to, my child’s participation in the BCC Malibu and travel to and from this event. I further agree to INDEMNIFY, DEFEND, and HOLD Berean HARMLESS from any and all liabilities, claims, judgements, costs and expenses, including reasonable attorney’s fees, made by other individuals or entities as a result of my child’s actions, behavior or inactions during the BCC Malibu and travel to and from this event. This indemnification shall survive the termination of the Release
4. My child agrees to abide by all the rules, regulations and safety instructions stated by Berean Christian Church, its agents and staff, and volunteers. I understand that Berean Christian Church will not be liable if my child fails to cooperate with regulations, and that any infraction of the rules may result in immediate dismissal from the retreat at my expense.

EMERGENCY CONTACT and MEDICAL AUTHORIZATION:

EMERGENCY CONTACT:

MEDICAL AUTHORIZATION: : I hereby give my permission to the medical personnel selected by Berean Christian Church staff and/or adult leaders to secure emergency medical treatment including, but not limited to, first aid, CPR, authorize emergency transportation, admission to any hospital, tests, surgery or general anesthesia, so long as care is provided by persons or facilities licensed in the state in which care is provided. I understand that a conscientious effort will be made to locate me in case of an emergency. However, in the event I cannot be reached in an emergency, I hereby give permission to the physician selected by Berean’s representative or adult leaders to secure and administer treatment, including hospitalization, for the child named above. I further acknowledge that any medical treatment ordered is my financial responsibility and not that of Berean Christian Church, Inc., its pastors, directors, officers, employees, volunteers, agents, guests, invitees, or affiliate entities.

I certify the above emergency contact information is true and correct and I consent to the medical authorization written above.

PHOTOGRAPH AND VIDEO RELEASE (OPTIONAL):

I agree and authorize any photograph, film or video taken of my child while participating in Berean Christian Church Malibu may be freely used to publish and republish for Berean Christian Church’s printed publication, website, social media, promotional and/or training materials.