RELEASE, WAIVER, AND INDEMNITY AGREEMENT by 11yflme

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									                       RELEASE, WAIVER, AND INDEMNITY AGREEMENT
                        YOUTH ACTIVITIES AT TRINITY UMC 2012-2013


It is the intention of ________________________________________ (Parent or guardian of minor) by this
agreement to exempt and relieve Trinity United Methodist Church and its officers, agents, servants, or
employees from liability for personal injury, property damage, or wrongful death of
___________________________________ (Name of minor) caused by any act of negligence of Trinity United
Methodist Church and its officers, agents, servants, or employees.
        For and in consideration of permitting said minor to observe, or use any facility or equipment of
Trinity United Methodist Church, or engage in and/or receive instruction in any activity or activity
incidental thereto SOME of which may involve dangers and risk of bodily injury at Trinity United
Methodist Church or engaging in or receiving instructions in any activities some of which may involve
dangers and risk of bodily injury or in activities incidental thereto wherever or however the same may
occur, and for whatever period said activities or instructions may continue.
        The undersigned parent or guardian of above named minor for him/herself, his/her heirs,
executors, administrators, or assigns agrees that in the event any claim for personal injury, property
damage, or wrongful death shall be prosecuted against Trinity United Methodist Church or its officers,
agents, servants, or employees, the undersigned parent or guardian will indemnify and hold harmless
Trinity United Methodist Church and its officers, agents, servants, or employees from any and all claims
or causes of action by above named minor or by any other person or entity, by whomever or wherever
made or presented, and under no circumstances will the undersigned parent or guardian of above named
minor present any claim against Trinity United Methodist Church and said persons for personal injuries,
property damage, wrongful death, or otherwise, caused by any act of negligence by Trinity United
Methodist Church and said persons.
        The undersigned parent or guardian represent that he/she has read this Release, has requested and
has been provided with, or has requested and declined advisement on the potential dangers/risks of
engaging in the observation, activities, or instruction offered, assumes all risks associated with such
dangers and risks, and is fully aware of and understands the terms and the legal consequences of the
signing of this Release. The undersigned parent or legal guardian intends his or her signature to be a
complete and unconditional release of all liability to the greatest extent allowed by law and if any portion
of the Release is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal
force and effect.




____________________________________________                              Dated: ________________
Signature of parent or guardian

For _____________________________________
       (Name of minor)
                                        Medical Information form
                                         Trinity UMC 2012-2013



Parent/Guardian Names: _______________________________________________________________

Home number: __________________________                    Work Number: _________________________
Cell Number: _________________________

Emergency Contact (name, relationship and phone number other than parents’ cell phone number)
_____________________________________________________________________________________
_____________________________________________________________________________________

Please list any pertinent medical information below, including medications being taken and known
allergies:
______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________


A photocopy of your child’s insurance card MUST accompany this form. It will not be considered
complete without it. ***In case of emergency, hospitals will not bill your insurance without a copy of the
card.

I understand that conduct problems will be dealt with accordingly, and if severe enough parents will be
responsible for picking their youth up.

______________________________________________                                      ___________________
Parent Signature                                                                    Date

______________________________________________                                      ___________________
Parent E-mail Address                                                               Phone Number

I will participate in all activities as planned for this trip/event, and will follow the rules as set forth by
adult and youth leaders.

______________________________________________                                      ___________________
Youth Signature                                                                     Date
                                         Trinity UMC

                   Photograph, video, and audio material permission form

                                           2012-2013



I, the undersigned, hereby consent to the use of any videotapes, photographs, slides,
audiotapes/CDs or any other visual or audio reproduction in which I may appear by Trinity
United Methodist Church. I understand that these materials are being used for promotion of the
youth ministry of Trinity United Methodist Church, which includes recruitment and fund raising
efforts.
    I release Trinity United Methodist Church from any liability connected with the use of my
picture or voice recording as part of any promotional, recruitment or fund raising program.

Student Signature _____________________________          Date______________
Parent/Guardian Signature ______________________         Date______________

								
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