Parental Consent & Release Agreement (LIFT)

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Parental Consent & Release Agreement (LIFT) I, the undersigned, am the parent or legal guardian of the child or youth (“Child”) named above. I warrant that I possess all the rights, powers and privileges of a parent/legal guardian necessary to execute this document with binding legal effect. As the parent/legal guardian of the Child, I certify and affirm that I have been completely and thoroughly informed that as a minor attending an event at or sponsored by Harvest Bible Chapel – Davenport (“HBC-D”/”Church”), my child will participate in certain activities which carry with them a degree of risk of injury.

Examples of risky activities include, but are not limited to: 1. Physical activities, both indoors and outdoors – large group games, arcade-style games, trampoline park activities/games, other group games TBD 2. Sports, both informal and organized – basketball, dodgeball, volleyball, other games TBD 3. Transportation/travel by vehicle(s) – school buses, leader/volunteer vehicles 4. Exposure to food products that may contain traces of nuts and nut oils or may have been made alongside other products containing nuts: students are allowed to bring snacks with them to LIFT for use at Host Homes. We will accommodate specialized dietary meals as best as possible while coordinating with third party caterers.

I acknowledge and understand that Harvest Bible Chapel - Davenport may offer other activities not listed above that present similar risks to my child. I acknowledge that participation in the activity described above involves risk to my child (and to the parents or guardians), and may result in various types of injury including, but not limited to, the following: sickness, bodily injury, death, emotional injury, personal injury, property damage and financial damage. I consent to my child’s participation in these activities. I acknowledge and understand that this PARENTAL CONSENT AND RELEASE AGREEMENT FOR PARTICIPATION IN MINISTRY ACTIVITIES has the same force and effect regardless of whether the activities engaged in are free or if a fee is charged. I also consent to allow my child to be transported to and from the above mentioned event/activities pursuant to the travel arrangements made by the church for the particular event/activities. Further, I personally assume, on my child’s behalf, all risk in connections with said activities for any harm, injury, or damages that may befall my child as a result of my child’s participation in the activities, whether foreseen or unforeseen, and I still wish to allow my child to proceed with the activities. In consideration for the opportunity for my child to participate in the activity described above (the “Activity”) and to use Harvest Bible Chapel - Davenport’s equipment and facilities, as well as rented, public, and/or personal equipment and facilities used while participating in a Harvest Bible Chapel - Davenport activity, on behalf of my child, and as to myself as parent/legal guardian, I acknowledge and accept the risk of injury associated with participation in and transportation to and from the Activity. I hereby voluntarily release, forever discharge, and agree to indemnify, defend and hold harmless Harvest Bible Chapel – Davenport, its officers, directors, employees, volunteers, agents, and contractors from any and all claims, demands, or causes of action, which are in any way connected with my child’s participation in these activities or use of church’s equipment and facilities. In cases of emergency, I further consent to the examination and/or treatment of my child by a physician duly licensed to practice medicine and/or any health care professional(s) duly licensed to provide health care services for medical care and services deemed necessary by Harvest Bible Chapel - Davenport, its agents, servants and

employees. I give permission to the physician and/or health care professional(s) to provide any and all medical care they deem, in their professional opinion, to be necessary. I agree to pay for any and all medical expenses incurred as a result of the use of this consent. I understand that it is my obligation to inform the ministry leaders and/or representatives of Harvest Bible Chapel Davenport of any and all health considerations or medical conditions that would restrict my child’s participation in any and all activities while at Harvest Bible Chapel – Davenport or attending an event sponsored by HBC-D. I will not allow my child to participate in any specific activities or events of the church which I know or should know would jeopardize my child’s health or safety based upon my child then-existing medical or health condition or that would subject other children or youth of the church to disease or illness. Should the need for medical attention arise, Harvest Bible Chapel - Davenport will attempt to contact you and/or the listed Emergency Contact, as soon as practicable under the circumstances. By signing this document, I acknowledge that if anyone is hurt or property is damaged during my child’s participation in these activities, I may be found by a court of law to have waived my right to maintain a lawsuit against Harvest Bible Chapel - Davenport on the basis of any claim from which I have released them herein. I agree that if any portion of this agreement is found to be void or unenforceable, the remaining portions shall remain in full force and effect. I have fully informed myself of the contents of this PARENTAL CONSENT AND RELEASE AGREEMENT FOR PARTICIPATION IN MINISTRY ACTIVITIES by reading it before I signed it. Please keep a copy for your records.

Signature of Parent/Legal Guardian: ____________________________________________________________ Print Name: ____________________________________________________ Date: ______________________

Signature of Parent/Legal Guardian: ____________________________________________________________ Print Name: ____________________________________________________ Date: ______________________