COLLEGE MINISTRY ~ WOLF RIDGE SKI RESORT
ASSUMPTION OF RISK, WAIVER, RELEASE AND HOLD HARMLESS AGREEMENT ("RELEASE")
A COMPLETED FORM MUST BE ON FILE BEFORE YOU CAN PARTICIPATE IN THE MINISTRY ACTIVITY
ELECTRONIC SIGNATURE CONSENT: You agree and consent to the use of a key pad, mouse, digit or other device to select an item, button, icon or similar act/ action in accessing or making any transactions regarding any waiver, release, agreement, acknowledgement, consent, terms, disclosures, authorizations, or conditions, constitutes your signature, acceptance, and agreement as if actually signed by you in writing. Further you agree no certification authority or other third party verification is necessary to the validity of your electronic signature; and the lack of such certification or third party verification will not in any way affect the enforceability of your signature or the resulting agreement between you and Berean Christian Church, Inc. In addition: Any electronic document bearing a user's electronic signature will be considered "in writing" and "signed". Any user's electronic-signed document shall be deemed to be an "original" document when printed and used in the normal course of business. Absent manifest error, the admissibility, validity, or use of any electronic‐signed electronic document cannot be contested.
I, the above named participant and undersigned, hereby acknowledge that I will participate in Berean Christian ChurchCollege Ministry Trip "Wolf Ridge Ski Resort" (hereinafter “BCC’s Activity”) to Mars Hill, North Carolina. BCC’s Activity shall depart January 5, 2018 and return January 7, 2018. The departure and return site is Berean Christian Church, 2201 Young Rd., Stone Mountain, Georgia 30088. I understand this activity involves highway travel as well as overnight stays at the following location: 578 Valley View Circle, Mars Hill, NC 28754.
As a condition of and in consideration of permitting me to participate in the BCC’s Activity and travel, I freely and voluntarily agree to sign this ASSUMPTION OF RISK, WAIVER, RELEASE AND HOLD HARMLESS AGREEMENT form ("RELEASE") in the space provided below indicating acknowledgment, consent and agreement with the following:
I, THE UNDERSIGNED PARTICIPANT, CERTIFY THAT I AM AT LEAST 18 YEARS OF AGE, COMPETENT AND 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, INC., ITS BOARD OF DIRECTORS, OFFICERS, PASTORS, EMPLOYEES, VOLUNTEERS, REPRESENTATIVES, AGENTS, AND AFFILIATE ENTITIES, IN REQUESTING AND RECEIVING THIS RELEASE, HAVE RELIED UPON THE SAME IN ALLOWING MY PARTICIPATION IN BEREAN CHRISTIAN CHURCH’S ACTIVITY. I ACKNOWLEDGE THAT I AM SIGNING THIS DOCUMENT FREELY AND VOLUNTARILY, AND INTEND BY MY SIGNATURE TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW.
EMERGENCY INFORMATION, CONTACT and MEDICAL AUTHORIZATION:
I certify that I am in good physical and mental health and able to participate in BCC’s Activity without medical supervision.
MEDICAL AUTHORIZATION: : I hereby give my permission to Berean Christian Church, Inc. assigned medical personnel or Berean College Ministry leaders (Berean representative) 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 jurisdiction of travel which includes Georgia, Alabama, Mississippi, and Louisiana. I understand that a conscientious effort will be made to locate my emergency contacts in case of an emergency. However, in the event such individuals cannot be reached in an emergency, I hereby give permission to the physician selected by Berean representative to secure and administer treatment, including hospitalization, for me. I further acknowledge that any medical treatment ordered is my financial responsibility and not that of Berean Christian Church, Inc., its board of directors, officers, pastors, employees, volunteers, agents, or affiliate entities.
I certify the above emergency contact information is true and correct and I consent to the medical authorization written above.
2201 Young Road
Stone Mountain, GA 30088
Phone: (770) 593-4421
Fax: (770) 593-9124