Hope Lutheran Release Form
Release Agreement By signing this document, you will
waive or give up certain legal rights, including the right to sue or claim
compensation following an accident. Please Read Carefully!
TO: Hope Lutheran Church (society) and its directors,
officers, staff members, volunteers, and representatives (hereafter referred to
as the “Releasees”).
A) I am aware that this retreat includes many activities and
that these activities include certain risks, dangers and hazards that include
personal injury or even death. I have familiarized myself with the schedule
provided on the registration form and am aware of the typical risks that may
arise from these activities. I agree to freely and fully assume all such risks,
dangers and hazards and the possibility of personal injury, death, or property
damage resulting therefrom.
B) I agree to waive any and all claims that I have or may
have in future against Hope Lutheran Church and to release the releasees as
well as its volunteers/staff members from any and all liability for any loss,
damage, expense or injury including death that I may suffer, or that my next of
kin may suffer resulting from this event, due to any cause whatsoever,
including negligence. I understand that negligence includes failure on the part
of the volunteers/staff to take reasonable steps to safeguard or protect me
from the risks, dangers and hazards referred to above.
C) I agree to hold harmless and indemnify the Releasees from
any and all liability for any damage to property of or personal injury to any
third party. This release agreement shall be effective and binding upon my
heirs, next of kin, executors, administrators, assigns and representatives in
the event of my death or incapacity.
D) I agree to surrender all medications (including
over-the-counter medications like Advil, Tylenol, etc) to the Releasees during
the stay at Hope Lutheran Church. I understand that the volunteers/staff will simply hold on to the
medications but will not administer them. a. I agree that the student in my
care knows how to take their own medication and knows their own dosage, as well
as the frequency of dosage. I understand it is my student’s responsibility to
approach the leaders and ask for the correct dosage and that the leader will
give the dosage coinciding with my written instructions on the registration
form. b. I relinquish 100% liability for the Releasees for any misuse of
medications that may result in bodily harm or even death.
I HAVE READ AND UNDERSTAND THIS RELEASE AGREEMENT AND I
AM AWARE THAT BY SIGNING THIS AGREEMENT, I AM WAIVING CERTAIN LEGAL RIGHTS
WHICH I OR MY HEIRS, NEXT OF KIN, EXECUTORS, ADMINISTRATORS, ASSIGNS AND
REPRESENTATIVES MAY HAVE AGAINST THE RELEASEES.
