Service Schedule

Heading H2

Example Paragraph Text

Directions

Heading H2

Example Paragraph Text

Name *
First Name
Middle
Last Name
Grade in August *
Please select your shirt size. *
Phone Number*
By selecting yes you are agreeing to all items listed below. Medical Authorization and Release/Wavier of Liability A completed Waiver is required for every participant to attend The Race 2017 at Westlake Church. The undersigned participant (“Participant”) in The Race 2017 sponsored by Westlake Church (WC and Participant’s parent(s) or legal guardian(s), in consideration of the benefits received from Participant’s participation in The Race 2017, individually affirm and agree that: 1. Acknowledgment of Risk. I fully understand and acknowledge that participating in The Race 2017 activities may entail hazards, dangers, and other risks to bodily health, safety, and well being. Such activities, risks, hazards, and dangers may include, but are not limited to, the following: inflatable game activities, dehydration, exposure to illness, physical games and activities and crowded areas, etc. I understand that the risks and dangers inherent in these activities may be caused by the negligence of participant in the activity, the negligence of others, accidents, breaches of contract, forces of nature, human hostilities, or other causes, and knowingly accept those risks. 2. Obligations of the Participant. As a condition of participating in The Race 2017, Participant shall (1) learn and consistently follow the rules governing The Race 2017 and its associated activities, (2) obey all instructions of the Race 2017 staff and volunteers, and (3) alert The Race 2017 staff immediately of any dangers or hazards to the safety of any individual(s) in The Race 2017 that participant perceives. 3. Permission. I give permission for Participant to participate in The Race 2017 and all of its associated activities, including but not limited to those described in Sec on 1, above. I also authorize The Race 2017 and Westlake Church its agents, and any agencies it works in conjunction on with to provide medical treatment to Participant, as specified below in Sec on 5, below, “Medical Authorization.” 4. Liability Waiver/Release. In consideration of Participant’s participation in The Race 2017, and intending to be legally bound, I hereby, for myself, my heirs, executors, and administrators, assume all risks and dangers identified above and hereby agree to release and hold harmless Westlake Church, its service providers, employees, volunteers, directors, officers, other agents, and any agencies it works in conjunction with from any and all liabilities, claims, demands, actions, or losses for or from bodily injury, property damage, sickness, wrongful death, loss of services, or otherwise, which may arise out of participants participation on in The Race 2017 or related activities and which may arise out of Participant’s participating in any activity associated with The Race 2017. 5. Medical Authorization on and Release. I understand that Westlake Church, will make every to contact Participant's parent(s) and/or guardian(s) in the event of a medical emergency. Nevertheless, I hereby give permission and authorize Westlake Church and its agents, at any me they believe an emergency exists, to provide, facilitate, and consent to the provision of any first aid, doctor’s care, hospitalization, surgery, transportation on to medical facility, and/or any other form of medical care or treatment that Westlake Church determines that Participant may need because of illness, injury, or other health problems that Participant may suffer while participating in The Race 2017 or its associated activities. I agree to be financially responsible for any medical bills incurred as a result of medical treatment for Participant. I agree to release and hold harmless Westlake Church and its employees, volunteers, directors, other agents, and any agencies it works in conjunction on with, from any claims, liabilities, actions, demands, or losses for or from bodily injury, property damage, wrongful death, or otherwise, which may arise from provision or omission of any type of medical care or transportation to or from a treatment facility by those chosen by Westlake Church to administer medical care for and/or transport Participant, and which may arise by any cause, including through the negligence or carelessness of Westlake Church its agents, or any agencies it works in conjunction with. I understand that all reasonable safety precautions will be taken at all by Westlake Church and its representatives during the events and activities. 6. Authorization to use Participant’s picture, name, voice, and likeness from The Race 2017. I grant to Westlake Church and to its successors, licensees, and assigns, the irrevocable right (but not obligation) to use Participant name, likeness, voice, photograph, and/or video image in program materials, promotional materials, highlight video, and other works, including but not limited to news releases, publications, lm or video programs, radio or TV announcements, Internet display, and for any other use by Westlake Church in its sole discretion. Westlake Church will own the picture images, voice, and/or likeness taken of Participant from The Race 2017 and has the right to modify or repurpose the images for its usage. 7. Indemnity. I agree to accept sole responsibility and liability for any injury or damage to a third party resulting from my acts or omissions and I agree to hold Westlake Church, its volunteers, employees, directors and agents harmless from any lawsuit or claim arising therefore, and I agree to indemnify Westlake Church, its volunteers, employees, directors, agents, and any agencies it works in conjunction with, in the full amount of any judgment or settlement obtained and/or any expense incurred (including attorney fees) as a result of my actions. 8. Severability. If any term or provision of this Agreement is found to be unenforceable, the remaining terms and provisions shall remain in full force and effect. *