Indemnification and Consent to Provide Medical Care
I hereby request the opportunity for the above-referenced Participant, to participate in below-referenced Activity, including transportation to and from this Activity. I am an adult and am fully competent to sign this Agreement. I am either the above-referenced Participant or I am the Parent or Guardian of the above-referenced Participant.
I give permission for Participant to participate in the above-referenced Activity. I acknowledge that the nature of the Activity may expose Participant to hazards or risks that could result in Participant's illness, personal injury or death and I understand and appreciate the nature of such hazards and risks.
In consideration of Participant being permitted to participate in the Activity, I hereby accept all risk to Participant's health and of his/her injury or death that may result from such participation and I hereby release Westbury Baptist Church, its councils, committees, deacons, officers, employees and representatives from any and all liability to Participant, Participant's personal representatives, estate, heirs, next of kin, and assigns for any and all claims and causes of action for loss of or damage to Participant's property and for any and all illness or injury to Participant's person, including his/her death, that may result from or occur during Participant's participation in the Activity. I further agree to indemnify and hold harmless Westbury Baptist Church and its councils, committees, deacons, officers, employees, and representatives from liability for the injury or death of any person(s) and damage to property that may result from Participant's negligent or intentional act or omission while participating in the described Activity.
In the event of injury to the above-listed Participant while participating in this Activity, permission is hereby granted to Westbury Baptist Church officials and employees or their designees to render, secure and authorize necessary medical treatment to the above-listed Participant.
I understand that no health insurance is to be provided by Westbury Baptist Church for this Activity and that in the event medical care is required for the above-listed Participant while participating in this Activity, I am responsible for furnishing the medical insurance information for the above-listed Participant:
I HAVE CAREFULLY READ THIS AGREEMENT AND UNDERSTAND IT TO BE A RELEASE OF ALL CLAIMS AND CAUSES OF ACTION FOR PARTICIPANT'S INJURY OR DEATH OR DAMAGE TO PARTICIPANT'S PROPERTY THAT OCCURS WHILE PARTICIPATING IN THE DESCRIBED ACTIVITY OR TRIP AND IT OBLIGATES ME TO INDEMNIFY THE PARTIES NAMED FOR ANY LIABILITY FOR INJURY OR DEATH OF ANY PERSON AND DAMAGE TO PROPERTY CAUSED BY PARTICIPANT'S NEGLIGENT OR INTENTIONAL ACT OR OMISSION.