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His House Ministries Permission Agreement

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His House Ministries Permission Agreement Powered By Docstoc
					                  His	
  House	
  Ministries	
  Permission	
  Agreement	
  &	
  Waiver	
  
In	
  consideration	
  of	
  me	
  (my	
  child)	
  being	
  allowed	
  to	
  participate	
  in	
  the	
  activities	
  of	
  His	
  House	
  Ministries,	
  I	
  (my	
  child)	
  
agree	
  to	
  hold	
  harmless	
  and	
  release	
  His	
  House	
  Ministries,	
  and	
  its	
  representatives,	
  including	
  but	
  not	
  limited	
  to,	
  the	
  
Pastor,	
  Minister	
  of	
  Youth,	
  paid	
  staff,	
  directors,	
  officers,	
  adult	
  sponsors,	
  and	
  adult	
  participants,	
  form	
  liability	
  for	
  any	
  
fault,	
  mistake,	
  negligence,	
  or	
  omission	
  causing	
  damage,	
  loss,	
  injury,	
  or	
  death	
  (hereinafter	
  referred	
  to	
  jointly	
  as	
  	
  
damage)	
  to	
  me	
  or	
  my	
  child	
  arising	
  from	
  my	
  (my	
  child’s)	
  participation	
  in	
  the	
  activities	
  or	
  transportation	
  to	
  and	
  from	
  
said	
  activities	
  of	
  His	
  House	
  Ministries.	
  The	
  wavier	
  also	
  included	
  any	
  damage	
  that	
  may	
  arise	
  from	
  the	
  provision	
  of	
  
emergency	
  medical	
  treatment.	
  

Further,	
  my	
  (my	
  child’s)	
  signature	
  below	
  acknowledges	
  that	
  I	
  understand	
  that	
  I	
  (my	
  child)	
  will	
  be	
  expected	
  to	
  
follow	
  all	
  rules,	
  guidelines,	
  and	
  policies	
  of	
  His	
  House	
  Ministries	
  this	
  included	
  following	
  the	
  directions	
  of	
  the	
  Pastor,	
  
Minister	
  of	
  Youth,	
  or	
  adult	
  sponsors	
  at	
  all	
  times.	
  I	
  (my	
  child)	
  understand(s)	
  and	
  acknowledge	
  (s)	
  that	
  repeated	
  
refusal	
  to	
  follow,	
  or	
  blatant	
  disregards	
  for,	
  the	
  rules,	
  guidelines,	
  policies,	
  and	
  directions	
  or	
  instructions	
  given	
  by	
  the	
  
Pastor,	
  Minister	
  of	
  Youth,	
  or	
  adult	
  sponsor.	
  	
  If	
  such	
  a	
  situation	
  develops	
  and	
  I	
  am	
  (my	
  child)	
  dismissed	
  from	
  an	
  
activity	
  of	
  His	
  House	
  Ministries,	
  I	
  acknowledge	
  and	
  accept	
  full	
  and	
  unconditional	
  responsibility	
  for	
  myself	
  (my	
  child)	
  
immediately	
  and	
  at	
  the	
  location	
  where	
  such	
  dismissal	
  occurs.	
  I	
  hereby	
  understand,	
  acknowledge,	
  and	
  accept	
  that	
  
this	
  may	
  be	
  at	
  any	
  location,	
  including	
  out	
  of	
  town,	
  and	
  that	
  I	
  will	
  be	
  solely	
  and	
  unconditionally	
  responsible	
  for	
  any	
  
and	
  all	
  expenses	
  associated	
  with	
  or	
  incurred	
  in	
  the	
  transportation	
  of	
  myself	
  (my	
  child)	
  back	
  to	
  my	
  (their)	
  home.	
  

For	
  Parents/Guardians	
  In	
  the	
  event	
  that	
  I	
  cannot	
  be	
  reached	
  in	
  case	
  of	
  emergency,	
  I	
  hereby	
  authorize	
  His	
  House	
  
Ministries	
  its	
  officers,	
  Pastor,	
  Minster	
  of	
  Youth,	
  Paid	
  staff,	
  adult	
  sponsors,	
  or	
  agents	
  to	
  make	
  emergency	
  medical	
  
decisions	
  (i.e.	
  doctors,	
  hospitals,	
  medical	
  treatment,	
  ect.)	
  and/or	
  administer	
  emergency	
  medical	
  assistance	
  as	
  they	
  
deem	
  necessary.	
  I	
  accept	
  responsibly	
  for	
  payment	
  of	
  expenses	
  incurred	
  as	
  a	
  result	
  of	
  any	
  medical	
  treatment.	
  

I	
  give	
  permission	
  to	
  His	
  House	
  Ministries	
  to	
  use	
  any	
  oral	
  or	
  written	
  comments	
  made	
  by,	
  and	
  any	
  photographs	
  or	
  
videos	
  taken	
  of	
  me	
  (my	
  child)	
  for	
  promotional	
  or	
  documentary	
  purposes.	
  

His	
  House	
  Ministries	
  and	
  its	
  representatives	
  will	
  never	
  knowingly	
  send	
  or	
  place	
  adults	
  or	
  young	
  people	
  into	
  a	
  
dangerous	
  situation.	
  His	
  House	
  and	
  its	
  representatives	
  will	
  take	
  reasonable	
  precautions	
  to	
  help	
  make	
  all	
  activities	
  
and	
  experiences	
  safe	
  and	
  fun	
  for	
  all.	
  	
  Despite	
  the	
  precautions,	
  occasionally	
  people	
  do	
  get	
  hurt	
  or	
  become	
  ill.	
  In	
  
light	
  to	
  this,	
  the	
  undersigned	
  hereby	
  recognizes	
  and	
  agrees	
  to	
  assume	
  all	
  risks	
  associated	
  with	
  the	
  activities	
  of	
  His	
  
House	
  Ministries.	
  

I	
  have	
  read	
  this	
  form	
  and	
  give	
  consent	
  for	
  me	
  (my	
  child)	
  to	
  participate	
  in	
  all	
  activities	
  of	
  His	
  House	
  Ministries,	
  Inc.	
  
                                                th                                            th
for	
  the	
  period	
  of	
  February	
  27 ,	
  2010	
  through	
  February	
  27 	
  2011.	
  To	
  release	
  and	
  waiver	
  form	
  is	
  valid	
  and	
  effective	
  
                                                                                                             th                                            th
for	
  activities	
  and	
  events	
  occurring	
  between	
  the	
  dates	
  of	
  February	
  27 ,	
  2010	
  and	
  February	
  27 	
  2011.	
  

__________________________________________________________	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  __________________	
  

Signature	
  of	
  Participant	
                    	
               	
                	
               	
                Printed	
   	
                     	
               	
  	
  	
  	
  	
  Date	
  

	
  

__________________________________________________________	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  __________________	
  

Signature	
  of	
  Parent/	
  Guardian	
                             	
                	
               	
                Printed	
   	
                     	
               	
  	
  	
  	
  	
  Date	
  
	
  

				
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posted:12/1/2011
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