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’s TakeOva Youth Conference Outreach Activity (hereinafter "Conference Activity" or "Activity"), scheduled Thursday, July 13, 2017. I understand this activity involves road and or highway travel. I also understand and acknowledge that Berean Christian Church, Inc. (hereinafter "Berean") is the legal entity that owns and operates the vehicle(s) used for transportation to the locations below
Berean Christian Church TakeOva Youth Conference has arranged several outreach Activity at several locations away from Berean Christian Church in which we request permission for the above named participant to attend. Please Note: Each participant will be assigned to serve at one of the following locations to perform the activity Thursday, July 13, 2017, 12:00 pm to 3:00 pm, described below:
Description of Activity
Grace Community Food Pantry
Grace Community Fellowship Church
4215 Wendell Drive, Suites E & F
Atlanta GA 30336 - 404-553-6716
Volunteers will sort food items and stock the shelves
Ronald McDonald House (Scottish Rite)
5420 Peachtree Dunwoody Road
Sandy Springs GA 30342
404-847-0760 or 470-426-8804
Volunteers will clean up the campus, prepare & serve meals
Ronald McDonald House (Egelston)
795 Gatewood Road NE
Atlanta GA 30329
404-315-1133 or 470-426-8804
Volunteers will clean up the campus, prepare & serve meals
City of Refuge
275 Pryor St SW, Atlanta GA 30303
Volunteers will help clean up the campus, prepare & serve approximately 300 meals
Senior Connections ATL
5238 Peachtree Road
Atlanta GA 30341 - 770-455-7602 x 115
Volunteers will serve meals to the residents
Keep DeKalb Beautiful (Farrington)
3097 Farrington Pkwy, Decatur, GA
Projects will consist of painting blocks and completing board paintings for boarded homes.
Request permission take pictures of participants.
As a condition and in consideration of allowing my child’s participation in the Activity, I, the undersigned parent or guardian, hereby give permission for my child to travel to, attend and participate in this Activity. 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:
- I certify that, in advance of my child’s participation in the Conference Activity, I am making an informed choice regarding my child’s participation in the Conference Activity which may include, but not limited to, transportation to and from Berean Christian Church (2201 Young Rd, Stone Mountain, GA 30088) to a location listed above. I understand the departure and return site is 2201 Young Road, Stone Mountain, Georgia 30088. I understand Berean staff and/or adult volunteers shall accompany my child during this activity.
- ASSUMPTION OF RISKS: I acknowledge, understand and agree that voluntary participation in the Conference Activity involves inherent risks, both known and unknown. These risk 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 Conference Activity, including, merely observing an activity and travel to and from this event.
- 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 or affiliate entities (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 Conference Activity 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 Conference Activity and travel to and from this event. This indemnification shall survive the termination of the Release.
- I certify that my child is in good physical and mental health and is able to participate in the Conference Activity without medical supervision.
- If a dispute over this Release or any claim for damages arises, on my behalf and my child’s behalf, I agree to resolve the matter through a mutually acceptable alternative dispute resolution process. If the parties hereto cannot agree upon such process, the dispute will be submitted to a three-member arbitration panel for resolution in accordance with the rules of the American Arbitration Association.
- Should any portion of this Release be deemed to be unenforceable or contrary to public policy, the remaining portions of this Release shall survive and be enforceable. This Release shall be governed by, subject to, and construed in all respects in accordance with the laws of the State of Georgia
I, THE UNDERSIGNED, CERTIFY THAT I AM AT LEAST 18 YEARS OF AGE, COMPETENT AND AM THE PARENT, LEGAL GUARDIAN, OR CUSTODIAN OF THE CHILD NAMED ABOVE. I CERTIFY TO THE BEST OF MY KNOWLEDGE, I HAVE PROVIDED TRUE, CORRECT AND ACCURATE INFORMATION IN THIS DOCUMENT, AND I HAVE READ THE ABOVE ASSUMPTION OF RISKS, WAIVER, RELEASE AND HOLD HARMLESS AGREEMENT PROVISIONS AND FULLY UNDERSTAND THE TERMS CONTAINED IN EACH PROVISION, AND UNDERSTAND THAT I AM GIVING UP SUBSTANTIAL RIGHTS, INCLUDING MY RIGHT TO SUE. I UNDERSTAND THAT BEREAN CHRISTIAN CHURCH, IN REQUESTING AND RECEIVING THIS RELEASE HAS RELIED UPON IT TO ALLOW MY CHILD’S PARTICIPATION IN THE TAKEOVA YOUTH CONFERENCE ACTIVITY AND TRAVEL. FURTHERMORE, I ACKNOWLEDGE THAT I AM SIGNING THIS DOCUMENT FREELY AND VOLUNTARILY.