Participant InformationInsurance InformationEmergency Information

In case of an emergency, if I am not available at the above phone numbers, contact:

Release of Liability
In consideration for Participant (my minor child or ward) being allowed to participate in any and all activities, I, for myself, my heirs, executors, administrators, assigns or personal representatives, release from liability and waive my right to sue Grace Community Church of Riverside, their employees, officers, volunteers and agents (collectively GCC) from any and all claims, including claims of GCC’s negligence, resulting in any physical injury, illness (including death), or economic loss I may suffer or which may result from Participant’s participation in activities, travel to and from activities (including air travel), or any events incidental to activities.

EXPRESSED ASSUMPTION OF RISK:
I am voluntarily allowing Participant to participate in activities. I understand that there are risks associated with participation in activities, such as physical and/or psychological injury, pain, suffering, illness, disfigurement, temporary or permanent disability, paralysis, death or economic loss. These injuries or outcomes may arise from Participant’s own or other’s actions, inactions, or negligence, or the condition of the activities’ location (s), facility (ies), dangerous or defective equipment or property owned, maintained or controlled by GCC. Nonetheless, I assume all risks for Participant’s participation in activities, whether known or unknown to me, including travel to and from activities or any events incidental to activities.

INDEMNIFY AND HOLD HARMLESS:
I agree to hold GCC harmless from any and all claims, suits or actions of any kind whatsoever for liability, damages, compensation or otherwise brought by me or anyone on my behalf, including attorney’s fees and any related costs, as a result of my participation in activities, including travel to and from activities or any events incidental to activities. If GCC incurs any of these types of expenses, I agree to reimburse GCC.

I acknowledge that GCC is NOT responsible for the errors, omissions, acts, or failures to act of any party or entity conducting a specific activity on their behalf.

PHOTOGRAPHIC RELEASE:
I understand while participating in activities, Partcipant may be photographed. I agree to allow Participant's photo, video, or film likeness to be used for any legitimate purpose by the activity holders, producers, sponsors, organizers, and assigns.

MEDICAL CONSENT:
I hereby consent to receive medical or dental treatment which may be deemed advisable by the medical personnel and representatives of GCC in the event of injury, accident, and/or illness during activities.

I, the parent/legal guardian, herein authorizes the adult leader/sponsor of any GCC activity or any responsible adult person bearing this written authorization into whose said care the above mention Participant has been entrusted to consent to any x-ray, examination, anesthetic, medical or surgical diagnosis or treatment and hospital care to be rendered to said minor child under the general or special supervision and upon the advice of a physician and/or surgeon licensed under the provisions of the California Medicine Practice Act, and to consent to an x-ray, examination, anesthetic, dental or surgical diagnosis or treatment and hospital care to be rendered to said minor by a dentist licensed under the provisions of the California Dental Practice Act. (CALIFORNIA CIVIL CODE SECTION 25.8 – AUTHORIZATION OF MEDICAL TREATMENT OF MINORS)

If Participant needs medical treatment as a result of their participation in activities, travel to and from activities, or any events incidental to activities, I agree to be financially responsible for any costs incurred as a result of such treatment.

It is understood that this authorization is given in advance of any specific diagnosis, treatment or hospital care being required, but is given to provide authority and power on the part of said adult supervision to give specific consent to mentioned physician or dentist in the exercise of their advised judgments.

I am aware that I should carry my own health insurance. If Participant needs medical treatment as a result of their participation in activities, travel to and from activities, or any events incidental to activities, I agree to be financially responsible for any costs incurred as a result of such treatment.

UNDERSTANDING AND ACKNOWLEDGEMENT:
I am the parent or legal guardian of the Participant. I am 18 years of age or older. I have read this document, and I am signing it freely. I understand the legal consequences of signing this document, including (a) releasing GCC from all liability on my and the Participant’s behalf, (b) waiving my and the Participants’ right to sue GCC, (c) and assuming all risks of Participant’s participation in activities, including travel to and from activities (including air travel) or any events incidental to activities. I allow the Participant to participate in activities. I understand that I am responsible for the obligations and acts of the Participant as described in this document. I agree to be bound by the terms of this document. No other representations concerning the legal effect of this document have been made to me.

I understand that this document is written to be as broad and inclusive as legally permitted by the State of California. I agree that if any portion is held invalid or unenforceable, I will continue to be bound by the remaining terms.

These authorizations shall remain effective indefinitely, unless revoked in writing and delivered to the GCC Ministry Direrctor of Participant's age group.

Parent or Guardian must sign below. Please type name as legal signature (Cal ETA, Civil Code Section 1633.7)