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REGISTRATION

PARENT/GUARDIAN INFORMATION

MEDICAL

MEDIA RELEASE

GRACE BIBLE CHURCH LIABILITY RELEASE

In consideration of the risk of injury while participating in classes/activities and as consideration for the right to participate in classes/activities, I hereby, for myself, my student, my heirs, executors, administrators, assigns, or personal representatives, knowingly and voluntarily enter into this waiver and release of liability and hereby waive any and all rights, claims or causes of action of any kind whatsoever arising out of my or my student’s participation in the classes/activities, and do hereby release and forever discharge Grace Bible Church located in Bellevue, NE, their affiliates, managers, members, agents, attorneys, staff, volunteers, heirs, representatives, predecessors, successors and assigns, for any physical or psychological injury, including but not limited to illness, paralysis, death, damages, economical or emotional loss, that I or my student may suffer as a direct result of my participation in the aforementioned classes/activities, including traveling to and from an event related to these classes/activities.

On behalf of myself and my student (hereafter “We” and “Our” and “Us”), we are voluntarily participating in the aforementioned classes/activities and we are participating in same entirely at our own risk. We are aware of the risks associated with traveling to and from as well as participating in these classes/activities and the potential for physical or psychological injury, pain, suffering, illness, disfigurement, temporary or permanent disability (including paralysis), economic or emotional loss, and death. We understand that these injuries or outcomes may arise from our own or others’ negligence, conditions related to travel or the condition of the class/activity locations. Nonetheless, we assume all related risks, both known or unknown to us, of our participation in this activity. 

I agree to indemnify and hold harmless Grace Bible Church against any and all claims, suits or actions of any kind whatsoever for liability, damages, compensation or otherwise brought by me or anyone acting on my behalf, including attorney’s fees and any related costs, if litigation arises pursuant to any claims made by me or by anyone else acting on my behalf. If Grace Bible Church or its associates incurs any of these types of expenses, I agree to reimburse Grace Bible Church.

I acknowledge that Grace Bible Church and their directors, officers, volunteers, representatives and agents are not responsible for errors, omissions, acts or failures to act of any party or entity conducting a specific event or activity on behalf of Grace Bible Church. 

I ACKNOWLEDGE THAT I HAVE CAREFULLY READ THIS “WAIVER AND RELEASE” FULLY & UNDERSTAND THAT IT IS A RELEASE OF LIABILITY. I EXPRESSLY AGREE TO RELEASE AND DISCHARGE GRACE BIBLE CHURCH AND ALL OF ITS AFFILIATES, MANAGERS, MEMBERS, AGENTS, ATTORNEYS, STAFF, VOLUNTEERS, HEIRS, REPRESENTATIVES, PREDECESSORS, SUCCESSORS AND ASSIGNS, FROM ANY AND ALL CLAIMS OR CAUSES OF ACTION AND I AGREE TO VOLUNTARILY GIVE UP OR WAIVE ANY RIGHT THAT I OTHERWISE HAVE TO BRING A LEGAL ACTION AGAINST GRACE BIBLE CHURCH FOR PERSONAL INJURY OR PROPERTY DAMAGE. 

 

If, in the opinion of a properly licensed and practicing physician, my student needs medical or surgical services that require my consent before being supplied and I cannot be reached, I hereby authorize, appoint, and empower the principal or his designee to furnish on my behalf such written or oral authorization as may be so required. Further, I release the classroom teacher or his designee, from any liability that might arise from the giving of such authorization, it being my desire that my student be furnished with such medical or surgical services as soon as reasonably possible after the need arises. 

I/We, the parent/guardians of the student named above, give our consent for him/her to attend events being organized by Grace Bible Church. I/We understand that there are inherent risks involved in any ministry, event or class. In the event that he/she is injured and requires the attention of a doctor, I/we consent to any reasonable medical treatment as deemed necessary by a licensed physician. In the event treatment is required from a physician and/or hospital personnel, I/we agree to hold such person free and harmless of any claims, demands, or suits for damages arising from the giving of such consent. I/We also acknowledge that we will be ultimately responsible for the cost of any medical care should the cost of that medical care not be reimbursed by the health insurance provider. Further, I/we affirm that the health insurance information provided above is accurate at this date and will, to the best of my/our knowledge, still be in force for the student named above.

I/we also agree to bring my/our child home should they become ill or if deemed necessary by a Grace Bible Church staff member or volunteer. 

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