Great Day of Service Joplin

# of Volunteers Over 13 including yourself

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Id Serivce Area Project # Location Description Leader # Volunteers Needed

College Heights Christian Church
Great Day of Service 2017
Release, Indemnification Agreement, Liability, and Parental Consent Agreement

If youth, I give permission for my son/daughter (Name of child) _____________________ to participate in the Great Day of Service, Sunday, September 24, 2017.

Youth: In permitting my child to participate in the Great Day of Service at College Heights Christian Church I agree to the following:

Adult: I desire to participate in the Great Day of Service at College Heights Christian Church, and as a part of that participation, I agree to the following:

I release from responsibility and forever waive any right I have for any action or any claim of any sort, including but not limited to: any personal injury, property damage, or wrongful death, whether known or unknown, against CHCC or any of its elders, officers, employees, representatives, agents, or volunteers (collectively referred to as "Releasees") that might occur as part of participation in this project.

I further indemnify and hold harmless the Releasees from any claim or litigation for compensatory or punitive damages, included but not limited to: judgments, assessments, and/or attorneys' fees arising out of participation in the Great Day of Service project.

I understand this Agreement is continuing in nature. I agree to it knowingly and voluntarily, and without duress or undue Influence.

I give College Heights Christian Church and any person acting under its authority permission to publish, distribute, broadcast, license, copyright, promote, and sell any form of visual, print, or audio recording of my participation, including application of any visual or auditory special effects. I release any claims of copyright or ownership, and agree that these materials may be duplicated or distributed with or without compensation or liability, in perpetuity.

I understand that CHCC is obtaining this release and assignment of copyright in order to conform to U.S. copyright laws and international copyright treaties and conventions.

For Youth Only: We (I) authorize an adult, in whose care the minor has been entrusted, to consent to any x-ray examination; anesthetic: medical, surgical, or dental diagnosis or treatment; and hospital care, to be rendered to the minor under the general or special supervision and on the advice of any physician or dentist licensed under the provisions of the Medical Practice Act on the medical staff of a licensed hospital, whether such diagnosis or treatment is rendered at the office of said physician or at said hospital.

The undersigned shall be liable and agrees to pay all costs and expenses incurred in connection with such medical and dental services rendered to the aforementioned child pursuant to this authorization.

Should it be necessary for our (my) child to return home due to medical reasons, disciplinary action, or otherwise, the undersigned shall assume all transportation costs.

Furthermore, we (I) hereby assume all risk of personal injury, sickness, death, damage, and expense as a result of participation in recreation and work activities involved therein. 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 expense incurred attendant thereto.

The undersigned does also hereby give permission for our (my) child to ride in any vehicle designated by the adult in whose care the minor has been entrusted while attending and participating in activities sponsored by College Heights Christian Church.

IN WITNESS WHEREOF, the undersigned hereby executes this Agreement on the date set forth below:

Please type your name to indicate you agree.
Parent or Legal Guardian