Habitat for Humanity

WAIVER, RELEASE, AND INDEMNIFICATION AGREEMENT FOR STUDENT MINISTRY EVENTS AND OTHER CHURCH RELATED ACTIVITIES
SINGLE EVENT WAIVER
This Waiver, Release, and Indemnification Agreement (the “Agreement”) is entered into as of the date signed below by the undersigned parent(s) or legal guardian(s) (“Parent/Guardian”) of the minor participant (the “Participant”) for the benefit of Christ Fellowship (the “Church”), its affiliates, officers, employees, agents, volunteers, representatives, and assigns (collectively, the “Released Parties”).
By signing this Agreement, the Parent/Guardian consents to the Participant’s participation in the Church’s student ministry activity listed below for the duration of the event, and agrees to the terms and conditions set forth herein.
I. SCOPE
This Agreement applies to the Church-sponsored activity listed below. The activity may include but is not limited to: overnight camps, retreats, recreational programs, mission trips, transportation to and from events whether provided by the Church or by individuals, and all other activities organized for the purposes of student engagement and growth whether held on church property or off church property.
This Agreement shall remain in effect for the duration of the event listed below. A new Agreement must be signed to participate in other events hosted by the Church.
II. ACKNOWLEDGEMENT AND ASSUMPTION OF RISK
The Parent/Guardian acknowledges and understand that participation in the listed activity involve inherent risks, including but not limited to: physical injuries, illness, accidents during recreational or overnight stays, transportation-related risks, unforeseen conditions on property or at facilities where the activity is being held, emotional risks, risks of medical complications, and other emergencies.
The Parent/Guardian acknowledges that while the Church will make reasonable efforts to provide a safe environment, some risks are unavoidable. By signing this Agreement, the Parent/Guardian voluntarily assumes all such risks on behalf of the participant and agrees that participation is entirely voluntary.
III. RELEASE, WAIVER OF LIABILITY, AND INDEMNIFICATION
The Parent/Guardian, on behalf of the participant and themselves, fully release and discharge the Released Parties from any and all liability, claims, demands, caused of action, damages, and expenses (including attorney’s fees) arising from or relating to participation in the activity. This release includes, but is not limited to: injuries, property damage, loss sustained during the activity, emotional stressors in relation to participation, and incidental or consequential damages resulting from participation.
The Parent/Guardian agrees to defend, indemnify, and hold harmless the Released Parties from any claims, causes of action, liabilities, or costs arising from: special, incidental or consequential damages, injury or loss caused by participant’s participation in the activity to others, parent/guardian’s breach of representations or obligations under this Agreement, and claims made by participant or their estate against the Released Parties.
IV. MEDICAL CONSENT AND EMERGENCIES
The Parent/Guardian hereby consents to the provision of first aid or emergency medical treatment for the participant in the event of illness or injury during the activity.
In the event of an emergency and when the parent/guardian cannot be contacted, the undersigned Parent/Guardian authorizes a representative of the Church to consent to medical care for the Participant. The Parent/Guardian authorizes Church representatives to act as the Participant’s “personal representative” and to be treated as the Parent/Guardian would for all purposes of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and shall (1) have access to all of the Participant’s “individually identifiable health information,” including any “protected health information,” (2) possess, without limitation, the Parent/Guardian’s right of access to inspect and obtain a copy of protected health information about the Participant and (3) possess, without limitation, the Parent/Guardian’s right to an accounting of disclosures of protected health information. This authority hereby granted applies to any information governed by HIPAA. This grant of authority is limited to the time until the Parent/Guardian can be contacted, at which point the Church representative shall cease to be the Participant’s personal representative.
It is understood that this authorization is given in advance of any special diagnosis, treatment, or hospital care being required, but it is given to provide authority and power on the part of the supervisor/church representative in the exercise of best judgment for the Participant’s care, upon advice by physician or other medical professional.
The Church does not assume financial responsibility for medical treatment or related costs. The Parent/Guardian is encouraged to ensure the Participant is covered by adequate health insurance. If covered by health insurance, the Parent/Guardian agrees to provide insurance card and information in advance, should it ever be needed.




V. PARTICIPANT CONDUCT
The Parent/Guardian acknowledges that the Participant is required to adhere to all rules, regulations, and codes of behavior set forth by the Church. These rules are, but not limited to: respect for other participants, staff, and property, compliance with safety instructions and guidelines, and prohibition of unsafe or inappropriate behavior.
Any violation of such rules may result in disciplinary action, including removal from the activity at the discretion of the Church.
VI. PHOTOS, VIDEOS, MOTION PICTURES, AND RECORDINGS
The Parent/Guardian grants full permission to the Church to use any photos, videos, motion pictures, recordings, and any other records or documents of the activity. No notice is required to be given to the Parent/Guardian and the Parent/Guardian will not be compensated for use of the photo for any purpose.
VII. COST AND EXPENSES
The Parent/Guardian assumes full responsibility for payment of the published and announced cost of the activity and agrees to pay that specified amount or any outstanding balance upon request by the Church. The Parent/Guardian assumes responsibility for any additional costs and expenses incurred by the Participant during the activity, including but not limited to: costs associated with medical care and other emergencies.
VIII. GOVERNING LAW
This Agreement shall be governed by and constructed in accordance with the laws of the State of Tennessee. Any dispute arising from or related to this Agreement or the activity shall be exclusively handled by the courts located in Tennessee.
IX. ACKNOWLEDGEMENT AND SIGNATURE
By signing below, the undersigned certifies that they are a parent/guardian of the Participant. The undersigned acknowledges that they have carefully read, understand this Agreement, and agree to its terms and conditions voluntarily and without reservation. The undersigned attest that the Participant is physically and mentally capable of participating in the activity outlined in this Agreement.

CF WAIVER
I am attending and participating in the activities of Christ Fellowship Church, 260 Victory Lane, Kingsport, TN 37664.
I understand that I will participate in various activities throughout this time period. By signing below, I acknowledge my participation as a volunteer in the upcoming programs or events (hereinafter the “Program”) as operated or sponsored by Christ Fellowship Church (hereinafter the “Church”):
In consideration for the Church allowing me to participate in Church’s Program activities, including but not limited to attendance and travel (hereinafter the “Activities”), I fully acknowledge the risks to which I will be exposed by volunteering to participate, and I hereby assume all such risks and waive all future claims against the Church for any property damage, personal injury, or death arising out of, or in any way connected with, the Activities in which I will participate, including the Activities, whether conducted on the Church’s premises or elsewhere, and including, but not limited to, any injury to person or property caused, in whole or in part, by the acts or omissions of the Church, its officers, directors, employees, agents, assigns, managers, contractors or members. The known risks assumed hereby may include, but are not limited to, vehicular collision, air traffic injury, recreational accident, drowning, insect or animal bite, and exposure to disease.
POWER OF ATTORNEY FOR HEALTHCARE

In the event of an emergency I also authorize a representative of Christ Fellowship Church to consent to medical care for myself (a copy of my insurance card is attached to this form). It is understood that this authorization is given in advance of any special diagnosis, treatment, or hospital care being required, but is given to provide authority and power on the part of the supervisor and my authorized designee, in the exercise of my best judgment of what is advisable for my care, upon advice of such physician, surgeon or provider.