Activity Waiver, Photo Release, and Medical Form

Additional Activity Waiver

Off-Property or Other Activities
Not Included in Normal Activities

Waiver, Release, and Covenant NOT to sue relating to participation in the activity listed below:
MUST BE SIGNED BY ALL PARTICIPANTS
The undersigned requests that I, or where applicable, the participant
has permission to participate in the activity on the following date:
under the supervision of
representing University Heights Baptist Church. All activities incidental or related to this activity are covered by and agree to the following terms:
1. I understand that I, or where applicable my minor child, will be solely responsible for the actions, conduct, and safety of the participant during the activity, including following all rules, regulations, and instructions.
2. I understand that there are certain risks inherent in participation in the activity and the incidental or related activities.
3. I knowingly and voluntarily assume the risk of injury, illness, or other harm due to any act, event, or omission related to my participation.
4. I understand that participation is voluntary.
5. I release, discharge, covenant not to sue, indemnify, hold harmless, and absolve the individual sponsors, University Heights Baptist Church, its staff, volunteers and members from and against any and all injuries, property damage, or any loss, damages, or expenses by or on behalf of the participant arising from or in any manner related to this activity.
6. If signing on behalf of a minor child, I understand that I am waiving and releasing any right of the minor child. Any right that any parent or guardian might have to sue or make claim against the sponsors, University Heights Baptist Church, its staff, volunteers and members for any act or omission, event, or injury to the minor child that they might sustain during the course of or arising out of this event.
I CAREFULLY READ THIS AGREEMENT AND FULLY UNDERSTAND THE CONTENTS. I AM AWARE THAT THIS AGREEMENT INCLUDES A WAIVER OR LIABILITY AND RELEASE, AN ASSUMPTION OF RISK, AND AN AGREEMENT BY ME TO IDENTIFY THE RELEASES, AND I SIGN IT OF MY OWN FREE WILL

Photo Release: I, the undersigned, hereby grant permission to University Heights Baptist Church to use photographs and/or video recordings of my child. PURPOSE:
  • Publicity
  • Social Media
  • Website Content
  • Printed Materials
  • Educational or Promotional Use
I understand that these images may be used in perpetuity without further notification or compensation.



Student Activities
Medical and Liability
Release Form

Description of Student Activities

University Heights Baptist Church (“UHBC”) plans various activities for its middle school, junior high, and high school students (“Student Activities”). Student Activities may include: Wednesday Nights for Students, Sunday Morning Bible Study, Sunday Night At Church, student outings and events including but not limited to: Disciple Now weekend, movie nights, picnics, retreats, mission trips, youth camp, conferences, parties, lock-ins, boating and swimming activities, ski trips, mall trips, and other various activities. Student Activities also include other activities planned by UHBC involving the students of UHBC and their friends and guests as announced from time-to-time by UHBC. Some or all of these may include transportation to and from the site of the activity.

Description of Student Activities

In consideration of UHBC permitting the above named Student to participate in the UHBC Student Activities, the undersigned agree to the acknowledgements, authorizations, releases, and agreements set forth in this Agreement. By entering into this agreement, the undersigned acknowledge that some of the Student Activities may involve hazardous activities that may have inherent risks that could result in injuries or death. The above-named Student has voluntarily chosen to participate in the Student Activities despite these associated risks, and the undersigned have voluntarily agreed to allow the Student to participate in the Student Activities despite such risks.

The undersigned, for themselves, their assigns, representatives, heirs, executors, and administrators, hereby:

(1) Authorize and grant to UHBC the authority, in the event that, after a reasonable effort, UHBC is unable to reach the undersigned or any of them, to seek medical care for the Student, including, but not limited to, such medical and surgical treatment or procedures as the treating physician chosen by appropriate UHBC personnel may, in such physician’s sole determination, deem necessary or advisable. The undersigned further authorize and grant UHBC and the appropriate personnel to transport the student at their discretion to such medical facilities as they may deem necessary or advisable. The undersigned certify that the Student’s medical information set forth on the 2013 Student Activities-Medical Information Sheet is complete and accurate. Each of the undersigned further certifies that he or she has adequate insurance to cover any injury or illness suffered by the Student during the Student Activities or agrees to bear all costs related to such injury or illness, including all medical and surgical costs incurred by UHBC for the Student upon the advice of the treating physician;

(2) RELEASE, WAIVE, DISCHARGE, AND INDEMNIFY UHBC, ITS MINISTERS, OFFICERS, EMPLOYEES, MEMBERS, AND AUTHORIZED VOLUNTEERS FROM ANY AND ALL LIABILITY, LOSS OR DAMAGE, AND ANY CLAIM OR DEMANDS FOR THE SAME ON ACCOUNT OF INJURY OR DEATH TO THE STUDENT OR DAMAGE TO THE UNDERSIGNEDS’ PROPERTY ARISING OUT OF OR RELATED TO THE STUDENT’S ATTENDANCE OR PARTICIPATION IN THE STUDENT ACTIVITIES (including, without limitation, the Student’s use of transportation, whether provided directly or indirectly by UHBC or any Releasees to or from any Student Activities);

(3) Acknowledge and understand that, in the event of the Student’s improper conduct or lack of cooperation with the UHBC personnel in charge of the Student Activity (as determined in the  sole discretion of UHBC personnel) and after a reasonable effort to contact the undersigned parent/guardian, UHBC may transport the Student home at the expense of the undersigned and the undersigned hereby expressly promise to pay directly to the transporter or by reimbursement to UHBC; and

(4) Understand and agree that nothing in the Agreement is intended to constitute a release or otherwise affect the rights of the undersigned against any third party independent from UHBC and the Releasees. Each of the undersigned is signing this document on his or her behalf and, in case of the parent signing below, on behalf of the Student, and each agree to be specifically bound to all terms and conditions of this Agreement. Each of the undersigned has read this agreement and fully understands that he or she is giving up substantial rights by signing it, is aware of its legal consequences, has signed this document freely and voluntarily and knowingly accepts all the terms and conditions as set forth above.

EACH OF THE UNDERSIGNED FURTHER ACKNOWLEDGES AND UNDERSTANDS THAT HIS OR HER SIGNATURE BELOW CONSTITUTES A RELEASE OF ANY LIABILITY OF UHBC AND THE RELEASEES.


Student Activities Medical Information Sheet

IN CASE OF EMERGENCY
HOSPITILAZATION INSURANCE
ALLERGIES (please be specific)
PRESCRIBED MEDICATIONS
(please list all that are taken routinely; use reverse side if necessary):
The undersigned certify that the student’s medical information set forth above on this Student Activities Medical Information Sheet is complete and accurate.


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