RUMC Liability Release 2023

In consideration for being accepted by Riverchase United Methodist Church for participation in All 2023 Riverchase UMC Youth Events, we (I), being 21 years of age or older, do for ourselves (myself) (and for and on behalf of my child-participant if said child is not 21 years of age or older) do hereby release, forever discharge and agree to hold harmless Riverchase United Methodist Church and the directors thereof from any and all liability, claims or demands for personal injury, sickness or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by the undersigned and the child participant that occur while said child is participating in the above-described trip or activity

Furthermore, we (I), [and on behalf of our (my) child-participant if under age of 21 years] thereby assume all risk of personal injury, sickness, death, damage, and expense as a result of participation in recreation and work activities involved therein.

Further, authorization and permission is hereby given to said church to furnish any necessary transportation, food, and lodging for this participant.

The undersigned further hereby agree to hold harmless and indemnify said church, its directors, employees, and agents, for any liability sustained by said church as the result of the negligent, willful or intentional acts of said participant, including expenses incurred attendant thereto. (If the participant has not attained the age of 21 years):

We (I) are the parent(s) or legal guardian(s) of this participant, and hereby grant our (my) permission for him (her) to participate fully in said trip, and hereby give our (my) permission to take said participant to a doctor or hospital and hereby authorize medical treatment, including but not in limitation to emergency surgery or medical treatment, and assume the responsibility of all medical bills, if any.

Further, should it be necessary for the participant to return home due to medical reasons, disciplinary action or otherwise, we (I) hereby assume all transportation costs.

2023 Liability Release

"*" indicates required fields

Name of Participant*

First Last

Participant's Date of Birth*

Participant's Address*

Street Address Address Line 2 City State ZIP Code

Participant's Gender*

Participant's Age*

Please enter a number less than or equal to 99.

Participant's Grade*

Parent/Guardian Name*

First Last

Insurance Company

Contract Number

Group Number

Physician

Physician's Phone

Emergency Contact

Emergency Contact's Phone

Parent 1 Cell

Parent 2 Cell

Acknowledgement*

I have read and agree to the information and requirements presented above.

(Only participant needs to sign if 21 years of age or older. If under 21, both parents must sign unless parents are separated or divorced in which case custodial parent must sign.)

Please initial below where indicated.

Parent 1 (initials)

Parent 2 (initials)

Legal Guardian (initials)

Trip Participant Only

I have read the forgoing and understand the rules of conduct for participants and will abide by them as well as the directions of the leadership of the trip.

Participant (initials)*

Comments

This field is for validation purposes and should be left unchanged.

2023 Liability Release

Hey Parents!