First Students Waiver & Parental Consent Form Emergency Medical Release and Liability Waiver



Emergency Contact Information

In an emergency when parent/guardian cannot be reached, please contact the following:

HEALTH CONCERNS (Please identify any allergies (to include foods), health problems, medications, or other health concerns):

This authorization for Emergency Medical Treatment must be completed before participant can participate in any activities. Treatment for injury will be based on information provided herein.

Disclaimer

First Montgomery and its leaders, directors, officers, employees, contractors, agents, volunteers, members and representatives (collectively referred to as “First Montgomery and/or First Montgomery Student Ministry”), are not responsible for any injury, loss or damage of any kind whatsoever sustained by any person or their property while participating in events, activities or travel with First Montgomery and all related activities associated with the First Montgomery, including injury, loss or damage.

Assumption of Risks

IN CONSIDERATION OF First Montgomery allowing me or my child to participate in events, activities, or travel with First Montgomery and all related activities associated with First Montgomery, including participation in the Student Ministry for one year (on the date this form was filled out) through the following year until the same date the next year (the same date this was electronically submitted) inclusive, and all activities related to the Student Ministry (collectively referred to as the “Activities”), I acknowledge that I am aware of the possible Risks, Dangers and Hazards associated with participation in the Activities including the possible risk of severe or fatal injury to myself or others.

RELEASE OF LIABILITY and AGREEMENT

IN CONSIDERATION OF First Montgomery allowing me or my child to participate in the Activities, I agree on behalf of myself and/or my child:

1. TO ASSUME and ACCEPT ALL RISKS arising out of, associated with or related to my or my child’s participation in the Activities.

2. TO WAIVE and RELEASE First Montgomery from any and all liability for any loss, damage, injury or expense that I or my child may suffer, or that my next of kin may suffer as a result of my or my child’s participation in the activities due to any cause whatsoever.

3. TO INDEMNIFY and HOLD HARMLESS First Montgomery from any and all liability for any damage to the personal property of, or personal injury to, any third party resulting from my or my child’s participation in the activities.

4. TO INDEMNIFY and HOLD HARMLESS First Montgomery from any and all claims, demands, actions and costs for any loss, injury, damage or expense whatsoever that might arise out of my or my child’s participation in the Activities.

STUDENT PARTICPATION CONSENT

Acknowledgment of Participant:

I, the undersigned Participant, understand that I am responsible to act in a safe and responsible fashion, to follow the instructions or directions of the persons in charge of the Student Ministry, and to obey requests to comply with safety regulations as directed by the persons in charge of the Student Ministry, including designated leaders and drivers of private or public transportation. I will be solely responsible for myself, will wear a seat-belt when available and will not disturb or distract the driver when using private or public transportation to travel to and from Student Ministry activities. At all Student Ministry sports events or other activities, I acknowledge that it is my responsibility to obtain and wear appropriate safety equipment. I will not endanger the safety of others or myself at any activities, outings or sports events of the Student Ministry or when using private or public transportation for travel to and from such activities. I also understand that I may be photographed or appear in video for such purposes as First Montgomery deems necessary.

Acknowledgment of Parent or Guardian of Participant:

We, the undersigned Parents or Guardians of the Participant, hereby authorize and consent to the Participant’s involvement in the Student Ministry, including any use of private or public transportation deemed necessary by the persons in charge of the Student Ministry for Participant travel to and from Student Ministry activities, or to the NEAREST SUITABLE MEDICAL or HOSPITAL FACILITY in the event that emergency or other medical treatment not available at the site of a Student Ministry activity is deemed advisable. We hereby consent to and authorize such emergency or other medical treatment of the Participant as may be deemed advisable in the event of accident, injury, or illness during the activities of the Student Ministry. We also understand that the participant may be photographed or appear in video for such purposes as the First Montgomery deems necessary.

ACKNOWLEDGEMENT and SIGNATURE

I UNDERSTAND THAT THIS IS A LEGAL AGREEMENT that is binding upon myself and my heirs, executors, administrators, successors, and assigns. I HAVE READ AND UNDERSTAND THE TERMS OF THIS AGREEMENT and I ACKNOWLEDGE THAT by signing this agreement voluntarily, I am agreeing to abide by its terms, and I am waiving certain legal rights that my child or I may have.

This Consent, Authorization and Acknowledgment shall be effective for one year from and including the date submitted below to and including date in one year (from when this was submitted electronically).

ELECTRONIC SIGNATURE ACKNOWLEDGEMENT AND CONSENT

I, the signer of this document, agree and understand that by signing this document and the Electronic Signature Acknowledgment and Consent, that all electronic signatures are the legal equivalent of my manual/handwritten signature and I consent to be legally bound to this agreement. I further agree my signature on this document is as valid as if I signed the document in writing. This is to be used in conjunction with the use of electronic signatures on all forms regarding any and all future documentation with a signature requirement, should I elect to have signed electronically. Under penalty of perjury, I herewith affirm that my electronic signature, and all future electronic signatures, were signed by myself with full knowledge and consent and am legally bound to these terms and conditions.