I understand that the student listed above (Student) will be participating in an event sponsored by Shepherd’s Gate Church (the Activity). I further understand and agree that neither Shepherd’s Gate Church, nor its leadership, representatives, employees, or agents may be held liable in any way for an incident in connection with the Activity which may result in injury, harm, or other damages to the Student.
I hereby assume all risk in connection with the Student’s participation in the Activity. I further release Shepherd’s Gate Church, its leadership, employees, agents, or representatives for any damage which may occur while the Student participates in the Activity. I further agree to save and hold harmless Shepherd’s Gate Church, its leadership, employees, agents, or representatives from any claim by me or the Student, our estates, heirs, or assigns arising out of or in connection with the Student’s participation in the Activity.
I understand that in the event medical intervention is needed, every attempt will be made to immediately contact the persons listed on this form. In the event that I or the contact persons listed on this form cannot be reached in an emergency during the Activity, I authorize Shepherd’s Gate Church, its leadership, employees, agents, or representatives to render or obtain such emergency medical care or treatment as may be necessary should any injury, harm, or accident (collectively, Injury) occur to my Student while participating in the Activity. I also authorize Shepherd’s Gate Church, to dispense to my child any over-the-counter medications (according to proper dosage instructions) when reasonably deemed necessary.
I understand that Shepherds Gate Church does not carry insurance coverage for the Activity and will not cover any or all of the Student’s medical or other expenses in the event of an Injury while participating in the Activity and that I am responsible for any and all medical costs in connection with an Injury. I represent that, to my knowledge, the Student is in good health and suffers no physical impairment that would or should prevent his/her participation in the Activity.
I grant and convey to Shepherds Gate Church all right, title, and interest in any and all photographs, images, video, or audio recordings of the Student or his/her likeness or voice made by Shepherds Gate Church in connection with the Student’s participation in the Activity.
I understand that this document is intended to be as broad and inclusive as permitted by the laws of the state of Michigan and that this Agreement shall be governed by and interpreted in accordance with the laws of the State of Michigan. I agree that if any portion of this Agreement is invalid, the remainder will continue in full legal force and effect.
I represent that I am authorized to sign this agreement as the parent and/or legal guardian of the Student.
