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Ridgedale Church 2023-2024 Children and Student Ministry

Activity Participation Agreement - Wavier and Release
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Student Information 

Full Name

** If you need to add another child/student please click the + Add another entry button below

Parental/Guardian Information

Emergency Contact

Full Name (Emergency Contact)

Medical Insurance Information

Information Regarding Special Medical Needs

Type NONE if there are no medical needs for any of the names listed above
wheezing, panting, difficulty breathing, seizures, swelling, discoloration of skin
Place the word NONE if there are no medications or medical equipment our ministry team should be aware of

Information Regarding Medications, Behavior

List each name and describe allergy if each student listed above has allergies.

Release Waiver

Consideration: I acknowledge the personal benefits accruing to me (and The Participant, as applicable) resulting from participation in church-sponsored events and am aware of the activities in which I (or The Participant(s) applicable) will be involved in through said participation.

Activity Release: I hereby declare and affirm that I am the parent or legal guardian of The Participant identified on this form or that I am the adult (at least 18 years old) participant identified on this form (“The Participant”) and that my consent and permission for The Participant’s participation in Church-sponsored events is legally sufficient and that no consent from any other person is required by law. I give my full and unqualified permission for The Participant to participate in all church-sponsored events during the current year August 1, 2022, to July 31, 2023, with the exception of the following: (Please list all events or activities from which you are withholding, limiting or otherwise qualifying your permission.)

Release/Indemnification: I hereby, in consideration of such benefits and other good and valuable consideration received, consent to the above-indicated participation and release absolutely, forever discharge, hold harmless, and covenant not to sue Ridgedale Church, its pastors, ministers, directors, officers, employees, agents, volunteers, and affiliates (Ridgedale Church LLC Knoxville, TN) from any and all present or future liability, claims, demands, actions, or rights of action, whether asserted by me or a third party arising out of participation in church-sponsored events (the “Claims”). I agree to indemnify Ridgedale Church for any such claims brought by me or a third party from any costs associated with defending or litigating such claims, including but not limited to attorney fees, costs, and legal expenses. Further, the participant (or parent/guardian) release and promises to indemnify, defend and hold harmless the activity sponsor for any injury arising directly or indirectly out of the described activity or transportation to and from the activity, whether such injury arises out of the negligence of the activity sponsor, the participant, or otherwise.
Assumption of Risk: I am aware of the risks associated with participation in Church-sponsored events and do hereby voluntarily assume full responsibility for any risk or loss, property damage, or personal injury, including death, that may result from participation in such events.

Appointment of Medical Authority: I hereby appoint the Church or its designee as my attorney in fact and vest any of them with authority to authorize any necessary dental, medical, or hospital care/treatment for The Participant. I further consent to any dental, medical, or hospital care deemed necessary by a licensed physician and/or by the Church or its designee and agree to hold such persons and/or Ridgedale Church harmless from any claims, demands, or suits for damages arising from such care and/or from consenting to such care.
I have included in this form a complete statement of medications, procedures, or other interventions that are required in the event of an emergency. I will provide all medications, inhalers, injectors, or other necessary items whenever the child is participating in Ridgedale activities.

I acknowledge and agree that, while the Ministry will attempt to take appropriate actions if such situations occur, the Ministry is not a medical facility and cannot be held liable for any resulting injury.

Acceptance of Medical Expenses: I agree to pay any and all medical expenses incurred in the care of The Participant. I hereby declare and affirm that my consent and agreement to pay any expenses resulting from any dental, medical, or hospital care/treatment provided to The Participant is legally sufficient and that no consent from any other person is required by law.

Media Release: I give my consent for the taking of photographs and/or video/audio recording of The Participant by Ridgedale Church and irrevocably waive and/or assign any and all rights (including copyright) in such media to Ridgedale Church. Ridgedale Church, as the sole owners of such media, shall have the exclusive right to control and determine the use, display, performance, reproduction, and dissemination of any such photographs and/or video/audio recordings. If a dispute over the media release arises, I agree to submit any Claims to a Christian conciliation/mediation organization for binding resolution or to a three-member arbitration panel for resolution in accordance with the rules of the American Arbitration Association.

Understanding: I represent and acknowledge that I have completely read and understand this document and all its terms and all matters referred to herein and I signed voluntarily as my free act and deed, that I have had an ample opportunity to obtain the advice of legal counsel and that, by signing this document, I understand that I am relinquishing legal rights and remedies that may have otherwise been available to me. I understand that this Waiver and Release shall be construed as broadly and inclusively as permitted by applicable law and agree that if any portion of this document is held invalid, the remaining shall continue in full force and effect. To the extent the restriction on filing lawsuits is deemed unlawful, I agree to submit any Claims to a Christian conciliation/mediation organization for binding resolution or to a three-member arbitration panel for resolution in accordance with the rules of the American Arbitration Association. It is understood and agreed that a copy of this form shall be treated as authentic and binding as the original.

Statement of Faith: By my signature below, I acknowledge that I have read The Statement of Faith and understand my child's or student's teacher, pastor, volunteer, etc. will teach in accordance with these principles. To review The Statement of Faith, see the church web page.


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Ridgedale Church 2023-2024 Children and Student Ministry

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