I, as the parent or guardian of my child/children, authorize the participation of my child/children in the use of Little Prairie Christian Church, Inc.’s (hereinafter “LPCC”) facilities including, but not limited to, the gym and surrounding area (commonly referred to as the “Family Life Center”) at LPCC in rural Albion, Edwards County, Illinois.
I understand that LPCC is a religious entity and that my use and/or my child’s/children’s use of LPCC’s facilities for any reason whatsoever and participation in any program, sporting event, group, or activity held at LPCC’s facilities is voluntary and not essential to completion of requirements of any program, school, or government agency. I understand that programs, sporting events, groups, or any other activities occurring at LPCC’s facilities may or may not be conducted by LPCC and its staff, employees, independent contractors, volunteers, and members. I further understand and agree that my use and/or my child’s/children’s use of LPCC’s facilities and/or participation in athletic and other activities occurring at LPCC’s facilities necessarily involves the risk of injury and even death from various causes, including but not limited to accidents, falls, strenuous physical activity, dehydration, illness, collision or dispute with other participants, weather-related injuries, playing area and equipment defects, and negligence of instructors, volunteers, staff, members, employees and other participants. On behalf of my child/children, me, and my family, I voluntarily assume these risks. In consideration of the privilege of me and my child’s/children’s use of LPCC’s facilities and participation in programs, sporting events, groups, or any other activities occurring at LPCC’s facilities, and on behalf of my child and me as parent/guardian, I hereby release, discharge, hold harmless and indemnify, and covenant not to sue LPCC and any of LPCC’s directors, officers, elders, trustees, deacons, employees, staff, members, attendees, volunteers, insurers, agents and representatives, and all other persons associated with LPCC (including without limitation any other participating churches, sponsors, parents, vendors, coaches, officials, drivers, and organizations) of and from any and all liability, claims, demands, actions and causes of action whatsoever of my child, me, my spouse, and other family members arising out of or related to any personal injuries suffered by me, my spouse or my child/children, property damage, medical expenses, and economic loss arising directly or indirectly out of my use, my spouse’s use, and/or my child’s/children’s use of LPCC’s facilities and participation in programs, sporting events, groups, or any other activities occurring at LPCC’s facilities, and any first aid, medical care or treatment provided to me, my spouse, and/or my child/children in the event me or child/children are injured or become ill while participating in programs, sporting events, groups, or any other activities occurring at LPCC’s facilities, and excepting claims that may not be released under applicable law. This Release of Liability shall be as broadly construed as allowed by law to include all claims and rights that I, individually, and as parent/guardian, my child/children, and other family members may have. I am a legally responsible parent or guardian of my child/children. If any provision of this Release of Liability is deemed invalid, the remaining provisions shall remain in full force and effect. This Release of Liability shall be binding on me, my family, heirs, next of kin, legal representatives, executors, administrators, guardians, beneficiaries, successors and assigns. I hereby authorize LPCC to use, reproduce, distribute, display, and to license others to use, reproduce, distribute, and display, me and/or my child’s/children’s image, and photograph, as well as any video, digital, or audio recording or reproduction, in connection with external and internal communications of LPCC for the sole purpose of advancing LPCC’s programs.
I agree to indemnify and defend LPCC, and all of LPCC’s directors, officers, elders, trustees, deacons, employees, staff, members, attendees, volunteers, insurers, agents and representatives, and all other persons associated with LPCC against all claims, causes of action, damages, judgments, costs or expenses, including attorney’s fees and other litigation costs by whomever made and wherever presented, which may in any way arise from my, my spouse’s, and/or my child/children’s use of LPCC’s facilities and participation in programs, sporting events, groups, or any other activities occurring at LPCC’s facilities.
I further agree to pay for all damages to the facilities of LPCC caused by me or my child/children’s negligent, reckless, willful, or intentional actions.
CONSENT TO MEDICAL TREATMENT
In the event me or my child/children are injured or become ill during use of LPCC’s facilities and/or participation in programs, sporting events, groups, or any other activities occurring at LPCC’s facilities, and if I, individually and as parent/guardian of my child/children, am not present to or have been rendered incapable of making medical decisions, I hereby authorize LPCC, its staff, employees, independent contractors, volunteers, and members, to arrange for and consent on my behalf to emergency medical and dental care and treatment, including tests and radiological exams, and surgery, and hospital care and treatment, and to consent to medications for pain and other conditions as prescribed by medical personnel attending me or my child/children. I am responsible for payment of any medical charges or expenses not covered by my insurance or the insurance applicable to my child/children (if any). My signature below indicates that all information provided in this form is true and accurate, and that I have read the form, understand the form, and fully and voluntarily agree to all statements made on the form, including but not limited to the Authorization, Release of Liability, Indemnity Agreement and Consent to Medical Treatment. My signature also indicates that all legal guardians are aware and consensual with the participation of the above-named child/children.
I HAVE READ THIS DOCUMENT AND UNDERSTAND IT. I FURTHER UNDERSTAND THAT BY SIGNING THIS DOCUMENT, I VOLUNTARILY SURRENDER CERTAIN LEGAL RIGHTS.
