1-501-249-5224

jason@harborcitychurch.net

Mailing Address:

P.O. Box 520223

Winthrop MA, 02152

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Parent/Guardian Consent & Liability Release

 

I, in consideration of the opportunity to participate in Soccer Nights, Adventure Camp and/or other Harbor City Church activities do hereby agree and acknowledge as follows:

1. I understand that participation in Soccer Nights, Adventure Camp and/or other Harbor City Church activities involves potential exposure to physically dangerous situations and may involve unavoidable risk of injury to participants or damage to property.

 

2. In consideration of the opportunity for my child to participate in Soccer Nights, Adventure Camp and/or other Harbor City Church activities, I agree to hold harmless and indemnify Harbor City Church and their employees, volunteers, agents, successors, heirs, estates, executors, administrators, and assigns from any and all claims, demands, actions, damages, and liabilities whatsoever which may directly or indirectly result from or be related to any loss, damage, or injury that may be sustained by my child or sustained by any other person or property, in connection with my child’s participation in Soccer Nights, Adventure Camp and/or other Harbor City Church activities.

3. I further agree to release and forever discharge Harbor City Church, their employees, volunteers, agents, successors, heirs, estates, executors, administrators, and assigns from all such claims, demands, actions, damages and liabilities whatsoever, which I may have, on behalf of my child whether foreseen or unforeseen, on account of my child’s participation in Soccer Nights, Adventure Camp and/or other Harbor City Church activities.

 

4. This release and discharge shall be binding upon the successors, heirs, estates, executors, administrators, and assigns of the undersigned.

 

5. I certify that, to the best of my knowledge, my child has no medical, psychological, or physical conditions that could interfere with his or her safety in Soccer Nights, Adventure Camp and/or other Harbor City Church activities, and that I am willing to assume and bear the costs of all risks that may be created, directly or indirectly, by any such condition.

 

6. In the event of illness or injury, I hereby authorize representatives of Harbor City Church to act for me according to their best judgment in any emergency requiring immediate medical attention, and hereby grant the right to take appropriate action for my child’s health and safety and to obtain any necessary medical assistance. I understand that the directors & coaches of Soccer Nights, Adventure Camp and/or other Harbor City Church activities, anyone associated with Harbor City Church will not assume responsibility for any medical or dental expenses incurred as a result of participation in this program, and those expenses shall be borne by me, as parent/guardian of my child, the registrant.

 

7. I give my consent to Harbor City Church to photograph,film, and/or use a photographic or digital reproduction of my child, to identify my child by name and/or to quote or record statements made by my child, for any editorial, promotional, or advertising purposes. I waive any right to inspect or approve the finished version(s). Harbor City Church and those who are authorized shall have the rights to reproduce, distribute, and display publicly, including on the Internet—photographs, film, videotape, statements, and quotes covered by this release, and to prepare derivative works. I understand Harbor City Church is not responsible for unauthorized duplication or use by third parties.

 

8. I acknowledge that I have read and fully understand this Consent & Liability Release and that I have signed voluntarily on the  Soccer Nights and/or Adventure Camp form.