EACH PARTICIPANT MUST PROVIDE THIS COMPLETED FORM PRIOR TO PARTICIPATION IN ANY CHURCH ACTIVITY. In consideration of my child being allowed to participate in church events and/or trips, I hereby RELEASE, WAIVE, DISCHARGE AND COVENANT NOT TO SUE The First Baptist Church of Florence, Mississippi, and their officers, servants, agents or employees (hereinafter referred to as RELEASEE) from any and all liability, claims, demands or causes of action whatsoever arising out of or related to any loss, damage or injury, including death, that may be sustained by me or my child, or to any property belonging to us, WHETHER CAUSED BY THE NEGLIGENCE OF THE RELEASEE, or otherwise while participating in any activity, event or trip or while in or upon the premises where any activity, event or trip is being conducted. To the best of my knowledge, my child is in good physical condition and I am unaware of any physical infirmity which would place my child at risk to participate in any way with any activity, event or trip. I am fully aware that there are risks involved in any activity, event or trip. I VOLUNTARILY ASSUME FULL RESPONSIBILITY FOR ANY RISK OF LOSS, PROPERTY DAMAGE OR PERSONAL INJURY, INCLUDING DEATH, that may be sustained to or by my child, or any loss or damage to property owned by us, as a result of being engaged in any activity, event or trip WHETHER CAUSED BY THE NEGLIGENCE OF THE RELEASEE or otherwise. I further hereby AGREE TO INDEMNIFY AND HOLD HARMLESS THE RELEASEE from any loss, liability, damage or cost, including, but not limited to, attorney’s fees and cost of court, that may accrue related to my child’s participation in any activity, event or trip, WHETHER CAUSED BY THE NEGLIGENCE OF THE RELEASEE or otherwise.
During the participation of my child in any activity, event or trip, I hereby give permission for The First Baptist Church of Florence, Mississippi, or their designated agent, to administer appropriate medical attention to my child in the event of an accident, illness or injury. I will be responsible for any and all cost of medical coverage and treatment provided not covered by insurance. It is my express intent that this Waiver of Liability and Indemnification Agreement and Consent to Medical Treatment shall bind the members of my family and spouse, if I am alive, and my heirs, assigns and personal representatives, if I am deceased and shall be deemed as a RELEASE, WAIVER, DISCHARGE AND COVENANT NOT TO SUE the above named RELEASEE. I hereby agree that this Hold Harmless Agreement/Consent to Medical Treatment shall be construed in accordance with the laws of the State of Mississippi. In signing this release, I acknowledge and represent that I have read, understand and have voluntarily executed this document; I am at least eighteen (18) years of age and fully competent; and I execute this release for full, adequate and complete consideration, fully intending to be bound by the same.
I HAVE READ THE WAIVER OF LIABILITY AND FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT. I FURTHER UNDERSTAND THAT THE DOCUMENT SHALL REMAIN IN FORCE PERPETUALLY UNLESS REVOKED BY ME IN WRITING. IT IS MY UNDERSTANDING AND AGREEMENT THAT A PHOTOCOPY OF THIS DOCUMENT WILL HAVE THE FULL FORCE AND EFFECT OF THE ORIGINAL.
