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Accident Waiver and Release of Liability Form and Media Release

I HEREBY ASSUME ALL OF THE RISKS OF PARTICIPATING AND OR/VOLUNTEERING IN THIS ACTIVITY OR 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 or activity.

 

I acknowledge that this Accident Waiver and Release of Liability Form will be used by the event holders, sponsors and organizers of the activity or event in which I may participate, and that it will govern my actions and responsibilities at said activity or event.

 
In consideration of my application and permitting me to participate in this event, I hereby take action for myself and assign as follows: 

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A.    I WAIVE, RELEASE, AND DISCHARGE from any and all liability, including but not limited to, liability arising from negligence or fault of the entities or persons released, for my personal injury, death, disability, or actions of any kind which may hereafter occur to me from this event, THE FOLLOWING ENTITIES OR PERSONS: The Marysville Area Ministerial Association dba the Hope Center and or their employees, volunteers, representatives, and agents, the activity or event holders, activity or event sponsors, activity or event 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 activity or event, whether caused by the negligence of release or otherwise.

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I acknowledge that The Marysville Area Ministerial Association dba the Hope Center and their directors, volunteers, representatives, and agents are NOT responsible for the errors, omissions, acts or failures to act of any party or entity conducting a specific or activity on behalf of The Marysville Area Ministerial Association dba the Hope Center.

 
I hereby consent to receive medical treatment which may be deemed advisable in the event of injury, accident, and/or illness during this activity or event.

 
The Accident Waiver and Release of Liability shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law. 


I CERTIFY THAT I HA VE READ THIS DOCUMENT, AND I FULLY UNDERSTAND ITS CONTENT. I AM A WARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT AND I SIGN IT OF MY OWN FREE WILL.

 
I hereby grant the Hope Center permission to interview me (or my child) and/or to use my (or my child's) likeness in 
photograph(s)/video in any and all of its publications and in any and all other media, whether now known or hereafter existing, controlled by the Hope Center, in perpetuity, and for other use by the Hope Center. I (or my child) will make no monetary or other claim against the Hope Center for the use of the interview and or the photograph(s)/video. 

If Participant is Under 18:

Thanks for submitting!

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WE HAVE MOVED

OUR NEW ADDRESS

The Hope Center

123 N. Court St. 

Marysville, OH 43040 

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937-303-4209 

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