Mount Moriah Church - Event Registration
Young Adult Field Day 2019
June 29, 2019 2:30 PM
Event Address: 1983 Brockett Rd, Tucker GA 30084
Name *
Your answer
Email *
Your answer
Spiritual Status *
Prayer Request
Your answer
Field Day Waiver
ACCIDENT WAIVER AND RELEASE OF LIABILITY FORM

EVENT: Mount Moriah Young Adult Field Day on June 29, 2019

I hereby assume all of the risks of participating in this EVENT, Including by way of example and not limitation, any risks that may arise from negligence or carelessness on the part of the persons or entities being released, from dangerous or defective equipment or property owned, maintained or controlled by them, or because of their possible liability without fault.

I certify that I am physically fit and have not been advised to not participate by a qualified medical professional. I certify that there are no health-related reasons or problems which preclude my participation in this EVENT. I acknowledge that this Accident Waiver and Release of Liability Form will be used by the organizers of the EVENT in which I may participate and that it will govern my actions and responsibilities at said EVENT.

In consideration of my application and permitting me to participate in this EVENT, I hereby take action for myself, my
executors, administrators, heirs, next of kin, successors, and assigns as follows:
(A) I WAIVE, RELEASE, AND DISCHARGE from any and all liability, including but not limited to, liability arising from the negligence or fault of the entities or persons released, for my death, disability, personal injury, property damage, property theft, or actions of any kind which may hereafter occur to me including my traveling to and from this EVENT. THE FOLLOWING ENTITIES OR PERSONS: Mount Moriah Church, and/or their agents, representatives or volunteers.
(B) I INDEMNIFY, HOLD HARMLESS, AND PROMISE NOT TO SUE the entities or persons mentioned in this paragraph from any and all liabilities or claims made as a result of participation in this EVENT, whether caused by negligence or otherwise.

I acknowledge that this EVENT may carry with it the potential for death, serious injury, and personal loss. The risks may include, but are not limited to, those caused by terrain, facilities, temperature, weather, condition of participants, equipment, vehicular traffic, actions of other people including, but not limited to, participants, volunteers, spectators, coaches, and lack of hydration.

I consent and agree that Mount Moriah Church, and/or their agents, representatives or volunteers may take photographs or digital recordings of me as a participant during this event and use these in any and all media for training or promotional purposes. I further consent that my identity may be revealed therein or by description text or commentary. I waive any rights, claims or interest and I understand that there will be no financial or other remuneration.

The accident waiver, release of liability and image release shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law.

I CERTIFY THAT I HAVE READ THIS DOCUMENT, AND I FULLY UNDERSTAND ITS CONTENT. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT AND I SIGN IT ON MY OWN FREE WILL.
Waiver Agreement *
Required
Parent/Guardian Waiver for Minors (under 18 years old)
PARENT/GUARDIAN WAIVER FOR MINORS (under 18 years old)

EVENT: Mount Moriah Young Adult Field Day on June 29, 2019

The Undersigned parent and or natural guardian does hereby represent that he/she is, in fact, acting in such capacity, has consented to his/her child or ward’s participation in the EVENT, and has agreed individually and on behalf of the child or ward, to the terms of the accident waiver and release of liability set forth above. The undersigned parent or guardian further agrees to save and hold harmless and indemnify each and all parties referred to above from all liability, loss, cost, claim, or damage whatsoever which may be imposed upon said parties because of any defect on lack of such capacity to so act and release said parties on behalf of the minor and the parents or legal guardian.
Parent Name
Your answer
Parent/Guardian Consent
Parent Email
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.