I (we) represent to Ruggles Baptist Church that I (we) am (are) the legal parent(s) or legal guardian(s) of the child(ren) listed on this form and I (we) consent to his/her attendance and participation in Family Fall Festival and all activities therein at Ruggles Baptist Church from October 28, 2023, sponsored by Ruggles Baptist Church. I (we) understand that in the event that medical intervention is needed, every attempt will be made to immediately contact the person(s) listed in this form and the emergency contact given upon registration. In the event I/we/they cannot be reached in an emergency during the activities shown on this form, I (we) hereby give my permission to the physician(s) or dentist selected by the activity sponsors to hospitalize, to secure x-ray examinations, to secure medical treatment and/or to order an injection, anesthesia, or surgery for my child as deemed necessary. I (we) understand that my (our) insurance coverage for my (our) child will be used as primary coverage in the event medical intervention is needed. Should it be necessary for the participant to return home due to medical reasons, disciplinary action, or otherwise, I (we) assume responsibility for their transportation and/or all transportation costs. I (we) acknowledge that participation in the activity described above involves risk to the participant (and to the participant’s parents or guardians, as the participant is a minor), 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. In consideration for the opportunity to participate in the activity described above (the “activity”), the participant (and the parent(s)/guardian(s) as the participant is a minor) acknowledge(s) and accept(s) the risks of injury associated with participation in the activity. The participant’s parent(s)/guardian(s) accepts personal financial responsibility for any injury or other loss sustained during the activity, as well as for any medical treatment rendered to the participant that is authorized by the sponsors or their agents, employees, volunteers, or any other representatives (collectively referred to as the “activity sponsors”). Further, the participant's parent(s)/guardian(s) releases and promises to indemnify, defend, and hold harmless the activity sponsors for any injury arising directly or indirectly out of the described activity or transportation to and from the activity, whether such injury arises out of the negligence of the activity sponsors, the participant, or otherwise. The undersigned parent(s) or guardian(s) represent that he/she/they has read this Release, has requested and has been provided with, or has requested and declined advisement on the potential dangers/risks of engaging in the observation, activities, or instruction offered, assumes all risks associated with such dangers and risks, and is fully aware of and understands the terms and the legal consequences of the signing of this Release. The undersigned parent(s) or legal guardian(s) intends his or her signature to be a complete and unconditional release of all liability to the greatest extent allowed by law and if any portion of the Release is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. If you agree, please electronically sign and date within the box below.

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