Kids/Youth Permission

Family Information

Student 1

Student 2

Student 3

Kids' and Youth Group 2022 Liability Release

My child has my permission to participate in the youth/children’s events and activities of Mt. Carmel Regular Baptist Church (MCRBC) events for the remainder of the 2022 year that are being held at 2331 US HWY BSN 340, Luray, VA, or are held at another location but sponsored by MCRBC. For MCRBC-sponsored events that are conducted/held off the MCRBC property, I authorize MCRBC to transport my child to the event, either in an MCRBC vehicle or in a private vehicle driven by an MCRBC staff member or volunteer. Activities I do not want my child to be involved in (e.g. water activities, types of sports, high-risk activities, etc.), include:

I give permission to have my child treated in case of medical emergency. In the event of a medical emergency and I cannot be reached, I hereby authorize MCRBC’s staff or volunteers, and/or emergency and medical personnel to make emergency medical decisions for my child. I acknowledge that MCRBC does not provide any health insurance covering my child during the activities referred to herein, and I further acknowledge that it is my responsibility to obtain health insurance covering said child. I agree to accept the sole responsibility for the costs of medical care.

I also grant permission to MCRBC and its representatives, contractors, employees and volunteers acting on behalf of MCRBC, to take and/or use, copyright, publish, edit, crop or treat images or likenesses of me or my child(ren), including photographs, videos or otherwise, for any lawful use on MCRBC website, social media pages, blogs, or in other official MCRBC printed or electronic publications without further consideration. I understand that this consent and release will operate in full force and effect until December 31, 2022 (or until such time as I withdraw my consent in writing). I understand that should photographs or videos of me or my child(ren) be used on MCRBC-owned or operated websites or webpages, they may be available for download.

 

I UNDERSTAND AND HEREBY AGREE TO ASSUME ALL THE RISKS WHICH MAY BE ENCOUNTERED AT THE ACTIVITIES SPONSORED BY MCRBC THAT MY CHILD WILL BE ATTENDING, INCLUDING TRANSPORTATION TO AND FROM SAID EVENTS. In consideration of my child being permitted to participate in the event(s) described above and other valuable consideration, the receipt of which is acknowledged, I hereby AGREE TO RELEASE, DEFEND, INDEMNIFY, AND HOLD HARMLESS MCRBC and its agents and employees from any and all past, present, and future, known and unknown liabilities, actions, causes of action, claims, expenses, personal injuries, and damages,INCLUDING THOSE CAUSED BY THE NEGLIGENCE OR FAULT OF MCRBC, ITS LEADERS, EMPLOYEES, OR VOLUNTEERS, and including without limitation, interest, penalties, court costs, attorney's fees and expenses resulting from or on account of injury to my child, myself, or my property in connection with any event anticipated by this form. I FURTHER RELEASE any and all claims brought by or through me, including claims for loss of consortium and all similar claims based on relationships with other people.

I EXPRESSLY AGREE that this release, waiver, and indemnity agreement is intended to be as broad and inclusive as permitted in the State of Virginia and that if any portion hereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. I ALSO AGREE that any controversy or claim, by or through the party signing this release, arising out of or relating to the activities anticipated by this form shall be settled by binding Christian arbitration conducted by the National Center for Life and Liberty or another Christian arbitrator, and judgment on the award may be entered in any court having jurisdiction thereof. This release contains the entire agreement between the parties hereto and the terms of this release are contractual and not mere recitals.

I FURTHER STATE that I have carefully read the foregoing consent and liability release and know the contents thereof and I sign this document as my own free act. This is a legally binding agreement which I have read and understand.

Medical Information