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EFCC Activity/Trip Release, Waiver, Indemnity and Assumption of Risk Agreement EFCC Activity/Trip Release, Waiver, Indemnity and Assumption of Risk Agreement

We at Emmanuel Faith Community Church and Mission Hills Church (EFCC / MHC) request that all
participants read and sign this Release, Waiver, Indemnity and Assumption of Risk Agreement to indicate that
they have accepted all risks personally when participating in sporting activities, music department outings,
mission trips, and youth outings sponsored by EFCC/MHC, including travel to these activities (collectively
Participation ). We strongly encourage anyone without medial insurance coverage not to expose themselves
and/or EFCC/MHC to the financial ramifications of possible injury from Participation.

The undersigned agrees as follows:

I fully understand and acknowledge that there are risks and dangers associated with Participation
which could result in property or bodily injury, partial and/or total disability, paralysis and death. These risks
and dangers may be caused by my action, inaction or negligence or that of other third parties, including the
Released Parties, as described below. There may also be other risks and dangers which are unknown or not
reasonably foreseeable at this time.

I accept and assume the risk and responsibility for any loses and/or damages for any such injury,
disability, paralysis or death, however caused and whether caused in whole or in part by the negligence of the
Released Parties.

I hereby release, waive, discharge and agree not to initiate any form of legal action against EFCC/MHC,
its pastors, elders, officers, agents, employees and volunteers (collectively Released Parties) for any and all
rights, claims, liabilities, lawsuits, damages, and expenses, including attorneys' fees, of any kind, known or
unknown, existing or arising in the future, including those arising from negligent conduct of the Released
Parties (Claims and Damages) which I have or may have in the future against Released Parties resulting from
or related to my Participation.

I further agree to indemnify and hold the Released Parties harmless against any Claims and Damages
arising out of or in any way connected with my Participation.

MY SIGNATURE BELOW INDICATES THAT I HAVE READ THIS ENTIRE DOCUMENT, FULLY UNDERSTAND
ITS TERMS, UNDERSTAND THAT IT AFFECTS MY LEGAL RIGHTS, AND AGREE TO BE BOUND BY ITS TERMS.

__________________________________________
PRINTED NAME OF PARTICIPANT

_______________________________________________ ________________________
SIGNATURE of Participant




DATE

Emergency contact person & phone
#:


______________________________________________________________________________________________________________________________________________________________________________________________________________

PARENT OR GUARDIANS ADDITIONAL INDEMNIFICATION
(Must be completed by legal guardian for participants under the age of 18)

In consideration of ________________________________ (print minors name) being permitted by EFCC/ MHC to
participate in this activity, I acknowledge that I have read and understand the attached Activity/Trip Release, Waiver,
Indemnity and Assumption of Risk Form, agree to be bound by its terms, and further agree to indemnify and hold
Released Parties harmless from any and all Claims and Damages which are brought by, or on behalf of Minor, and which
are in any way connected with such Participation by Minor. If I can not accompany the Minor in this event, I authorize the
EFCC Kids Lighthouse (EFCC Childrens Ministry) staff person(s), or their representatives, in charge of this
activity/trip/camp to accompany and take full responsibility for the minor.

Parent or Guardian: _______________________________ Print Name: ______________________________

Person responsible for minor: _______________________ Print Name: ______________________________

*Digital pictures and videos are taken during student activities. These pictures and/or videos may be used on the Emmanuel
Faith Community Church Kids Lighthouse (Childrens Ministries) web pages, in printed church publications (examples:
OnPurpose newsletter, worship folder, etc.), and/or in PowerPoint ministry reports, etc. Student and parent (if under 18) must
sign and date to authorize digital pictures or video of students to be used in these EFCC communications vehicles. Pictures will
not include students name or any other form of identification (unless specifically requested for items like newsletter articles).

I authorize digital pictures and/or video of me to be included on the EFCC web site or in other communications pieces:

*Students signature_________________________________________________________ Date______________________________

I authorize digital pictures and/or video of my child to be included on the EFCC web site or in other communications pieces:

*Parents signature__________________________________________________________ Date______________________________

PLEASE COMPLETE ADDITIONAL MEDICAL RELEASE FORM AND ATTACH PROOF OF MEDICAL INSURANCE COVERAGE