I, the undersigned parent or guardian, hereby consent for my child(ren), to participate in the Heritage Baptist Church of Wallingford, CT, NAVIGATE Youth Ministry activities on April 11-15, 2019 travelling to Hickory, North Carolina for the National Old Time Youth Rally hosted by New Manna Baptist Church. I certify that my child is able to participate in the activities held during this event. If my child has medical conditions which may be relevant to a physician in the event of an emergency, I have listed them on the registration form. In the event an emergency occurs, I may be reached at the telephone number listed below. If I cannot be reached, I hereby authorize Pastor Rob Treloar and Mrs. Kerri Urbanowicz to make emergency medical decisions for my child. If there are any activities in which I do not want my child to be involved, I have listed them on the registration form.
I UNDERSTAND AND HEREBY AGREE TO ASSUME ALL OF THE RISKS WHICH MAY BE ENCOUNTERED DURING THE PROGRAM, INCLUDING ACTIVITIES PRELIMINARY AND SUBSEQUENT THERETO. I do hereby agree to hold Heritage Baptist Church and its agents and employees harmless from any and all liability, actions, causes of actions, claims, expenses, and damages on account of injury to my child or property, even injury resulting in death, which I now have or which may arise in the future in connection with the activity or participation in any other associated activities.
I expressly agree that this release, waiver, and indemnity agreement is intended to be as broad and inclusive as permitted by law of the state of Connecticut, Maryland, North Carolina, and New Jersey and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full and legal force and effect. This release contains the entire agreement between the parties hereto and the terms of this release are contractual and not a mere recital.