2024 Hope Students liability waiver

Event REgistration form

Please fill out the FORM BELOW. This form will be used for all Upcoming events for THE 2024 YEAR AT Hope Student Ministry.

Student Name

First Name

Last Name

Student Cell

(###)

###

####

Student Grade

Student Shirt Size

Student Allergies / Medical Conditions

Parent/Legal Guardian Name

Parent/Legal Guardian Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact

First Name

Last Name

Emergency Contact Phone

(###)

###

####

Doctor Name

First Name

Last Name

Doctor Phone

(###)

###

####

Insurance Company

Group / Member Number

Please Read and Sign Below

DISCLAIMER Hope Fellowship Church, Hope Student Ministries and its leaders and volunteers are not responsible for any injury, loss or damage of any kind whatsoever sustained by any person or their property while participating in events, activities or travel with Hope Fellowship Church and all related activities associated with the Hope Fellowship Church, including injury, loss or damage. ASSUMPTION OF RISKS IN CONSIDERATION OF Hope Fellowship Church allowing my child to participate in events, activities, or travel with Hope Student Ministries and all related activities associated with the Hope Fellowship Church, including participation in the Student Ministry from January 1,2023 through December 31st, 2023 inclusive, and all activities related to the Student Ministry (collectively referred to as the “Activities”), I acknowledge that I am aware of the possible Risks, Dangers and Hazards associated with participation in the Activities including the possible risk of severe or fatal injury to myself or others. RELEASE OF LIABILITY and AGREEMENT IN CONSIDERATION OF Hope Fellowship Church allowing my child to participate in the Activities, I agree on behalf of my child: 1. TO ASSUME and ACCEPT ALL RISKS arising out of, associated with or related to me or my child’s participation in the Activities. 2. TO WAIVE and RELEASE Hope Fellowship Church from any and all liability for any loss, damage, injury or expense that I or my child may suffer. 3. TO INDEMNIFY and HOLD HARMLESS Hope Fellowship Church from any and all liability for any damage to the personal property of, or personal injury to, any third party resulting from my or my child’s participation in the activities. 4. TO INDEMNIFY and HOLD HARMLESS Hope Fellowship Church from any and all claims, demands, actions and costs for any loss, injury, damage or expense whatsoever that might arise out of my or my child’s participation in the Activities. Acknowledgment of Parent or Guardian of Participant: I, the undersigned Parent or Guardian of the Participant, hereby authorize and consent to my child’s involvement in Hope Student Ministries, including any use of private or public transportation deemed necessary by the persons in charge for Participant travel to and from Hope Student Ministry activities, or to the NEAREST SUITABLE MEDICAL or HOSPITAL FACILITY in the event that emergency or other medical treatment not available at the site of a Student Ministry activity is deemed advisable. We hereby consent to and authorize such emergency or other medical treatment of the Participant as may be deemed advisable in the event of accident, injury, or illness during the activities of the Student Ministry. We also understand that the participant may be photographed or appear in video for such purposes as the Hope Fellowship Church deems necessary. I UNDERSTAND THAT THIS IS A LEGAL AGREEMENT. I HAVE READ AND UNDERSTAND THE TERMS OF THIS AGREEMENT and I ACKNOWLEDGE THAT by signing this agreement voluntarily, I am agreeing to abide by its terms. This Consent, Authorization and Acknowledgment shall be effective from and including June 17th, 2021 to and including December 31st, 2021.

have questions?

Call or Email our Student Pastor Andrew Summers

615-462-5081 |Andrew@HopeSmyrna.com