Date*
Student Name*
Address*
Date of Birth*
Parent / Guardian*
2nd Parent / Guardian
Add Another Student*
2nd Student's Name*
2nd Student's Date of Birth
Add A 3rd Student
3rd Student's Name
3rd Student's Date of Birth
Add A 4th Student
4th Student's Name
4th Student's Date of Birth
Add A 5th Student
5th Student's Name
5th Student's Date of Birth
Add A 6th Student
6th Student's Name
6th Student's Date of Birth

FOR PARENTS/GUARDIANS OF PARTICIPANTS OF MINORITY AGE

(UNDER AGE 18 AT TIME OF REGISTRATION)

This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree to his/her release as provided above of all the Releasees, and, for myself, my heirs, assigns, and next of kin, I release and agree to indemnify and hold harmless the Releasees from any and all liabilities incident to my minor child’s involvement or participation in these programs as provided above, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASES, to the fullest extent permitted by law.

PARTICIPANT RELEASE OF LIABILITY – READ BEFORE SIGNING

In consideration of being allowed to participate in any way in the KLIFE Ministries program, related activities and events, I, the undersigned, acknowledge, appreciate, and agree that:

  • The risk of injury from the activities involved in this program is significant, including the potential for permanent paralysis and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and,
  •  I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEE or others, and assume full responsibility for my participation; and,
  • I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest staff or volunteer immediately; and,
  • I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS THE KLIFE MINISTRIES ORGANIZATION, their officers, agents and /or employees, other participants, sponsoring agencies, sponsors, advertisers, and, if applicable, owners and lessors of premises used to conduct the event (“Releasees”), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law.
  • I understand that photographs and video footage taken of me as a result of participation in these programs may be used in KLIFE Ministries materials, publications, and/or posted to the internet. By signature below, I waive any right that I may have to inspect or to approve the materials that KLIFE Ministries may choose to publish.
  • We (I) do hereby grant permission of KLIFE staff and/ or KLIFE representatives to communicate (digitally, written, verbal, or in-person) with me or my student in compliance COPPA law. I understand that I do have the option to opt-out of all or some KLIFE communications if we (I) so wish.
  • We (I) do hereby grant permission of KLIFE staff to take said participant to a physician or hospital, and hereby authorize medical treatment including but not in limitation to any x-ray examination, anesthetic, medical or surgical or dental diagnosis or treatment, and hospital care. The Undersigned shall be liable and agree(s) to pay all costs and expenses incurred in connection with such medical services rendered to our (my) participant pursuant to this authorization.
  • I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.
  • I acknowledge that KLIFE has provided their plans to take reasonable precautions to mitigate the risks associated with any infectious disease by following CDC and local authority guidelines.  I understand that such risks cannot be eliminated entirely, as an infectious disease may spread through multiple pathways.  I also understand that although reasonable precautions are taken, my child may still contract an illness.  I also understand the health risks associated with an infectious disease including potential exposure to others including family members.
  • I expressly agree to accept and assume all risks associated with infectious diseases related to my child’s participation in KLIFE.  I have elected to allow my child to participate in the Program despite the risks of contracting an infectious disease. I recognize that this decision is purely voluntary and that I have the right to discontinue my child’s participation in the KLIFE at any time.
  • I understand that KLIFE may modify and/or cancel KLIFE programming as a result of infectious disease issues or may be directed to modify and/or cancel programming by government authorities.
  • I understand that KLIFE reserves the right to segregate, remove, quarantine, and/or dismiss my child for infectious disease reasons and take all reasonable steps to maintain and protect the health and welfare of my child and other students, staff, and volunteers.
  • I acknowledge that I may elect to receive and KLIFE will provide a deposit refund should I cancel my child’s participation in KLIFE programming for reasons related to an infectious disease prior to the start date of any KLIFE trip or event for which he/she is registered. I will remain solely responsible for my other costs incurred in connection with my child’s participation in KLIFE programming, including transportation, lodging and incidental costs, even in the event that KLIFE is required to or deems it necessary to cancel or modify programming.
  • I represent to KLIFE or will represent to KLIFE prior to presenting my child for participation in programming that, to my knowledge, my child (a) has not been diagnosed with an infectious disease, (b) has not been exposed to a person presumed or confirmed to have an infectious disease within the fourteen days preceding my child’s participation in KLIFE programming, and (c) is free of any signs and symptoms of an infectious disease (which may include a fever, a dry cough, excessive fatigue, shortness of breath).  I represent I will notify KLIFE of any change in my child’s medical status that occurs upon the continuation of my child’s participation in KLIFE programming.
  • I HEREBY VOLUNTARILY RELEASE, WAIVE, AND FOREVER DISCHARGE ANY AND ALL CLAIMS AGAINST KLIFE MINISTRIES, ITS BOARD OF DIRECTORS, OFFICERS, EMPLOYEES, VOLUNTEERS, AGENTS AND ALL OTHER PERSONS OR ENTITIES AFFILIATED WITH KLIFE OR ACTING ON ITS BEHALF THAT RELATES IN ANY WAY TO INFECTIOUS DISEASES, INCLUDING BUT NOT LIMITED TO ANY CLAIM ARISING FROM OR RELATING TO MY CHILD’S EXPOSURE TO, INFECTION WITH, OR OTHER HARM RELATED TO INFECTIOUS DISEASES WHILE PARTICIPATING IN KLIFE PROGRAMMING AND/OR FOLLOWING PARTICIPATION IN PROGRAMMING, AND ALSO INCLUDING HARM RELATED TO MY CHILD’S SPREAD OF SAID DISEASES TO ME AND/OR OTHERS INCLUDING FAMILY MEMBERS.  I FURTHER AGREE TO REIMBURSE KLIFE FOR ATTORNEY FEES INCURRED RELATED TO ENFORCING THIS WAIVER PROVISION.
  • I agree to indemnify and hold harmless KLIFE from and against any liabilities, claims, causes of action, suits, losses, fines, judgments, settlement, and expenses (including reasonable attorney fees) which may be incurred by KLIFE as a consequence of my child’s exposure to an infectious disease resulting in the illness or infection of a third-party.
  • The provisions of this Wavier are severable, and if any provision of this is held to be invalid or unenforceable, the remaining provisions will remain in full force and effect.
Are You Interested In Your Student(s) Joining A KLIFE Small Group?*
Use your mouse or finger to draw your signature above
Powered by Formstack Create your own form ›
Cancel
Confirm