PARENT SIGNATURE AND DATE *
My child has my permission to participate in the Long Island Abundant Life Church events that are being held on Monday to Friday on August 7, 8, 9, 10, and 11, 2023 at 7-19 East Marie Street and 24 East Nicholai Street, Hicksville NY 11801. I give permission to have my child treated in case of medical emergency. In the event of a medical emergency and I cannot be reached, I hereby authorize LIALC staff or volunteers, and/or emergency and medical personnel to make emergency medical decisions for my child. I understand and hereby agree to assume all of the risks which may be encountered at the activities sponsored by LIALC that my child will be attending pursuant to this consent and release form. I hereby agree to release, defend, indemnify, and hold harmless LIALC and its agents and employees from any and all past, present, and future, known and unknown liabilities, actions, causes of action, claims, expenses, and damages (including without limitation, interest, penalties, court costs, attorney's fees and expenses) resulting from or on account of injury to my child, myself or my property or his/her/their property in connection with any event anticipated by this form. I further release any and all claims brought by or through me, including claims for loss of consortium and all similar claims based on relationships with other people. I expressly agree that this release, waiver, and indemnity agreement is intended to be broad and inclusive as permitted in the State of NEW YORK. and that if any portion thereof is held invalid, it is agreed that the remainder shall, notwithstanding, continue in full legal force and effect. I also agree that any controversy or claim, by or through the party signing this release, arising out of or relating to the activities anticipated by this form shall be settled by binding Christian arbitration conducted by the National Center for Life and Liberty or another Christian arbitrator, and judgment on the award may be entered in any court having jurisdiction thereof. This release contains the entire agreement between the parties hereto and the terms of this release are contractual and not a mere recital. I further state that I have carefully read the forgoing release and know the contents thereof and I sing this release as my own free act. This is a legally binding agreement which I have read and understand.