Functions and Activities

I understand that the person(s) named above will be transported by Roll To Church, Inc. to and from a partnering church. I acknowledge that there are certain risks associated with the activities, including, by way of example, physical injury due to activity-related accidents, physical injury due to transportation-related accidents, illness, or even death. In addition, I acknowledge that there may be other risks inherent in these activities of which I may not be presently aware.

Release of Liability

By signing this Permission/Waiver Form, I expressly warrant that the person(s) named above is capable of withstanding both the physical and mental demands of the activities discussed above. I also expressly assume all risks of the person(s) participating in the activities, whether such risks are known or unknown to me at this time. I further release this organization and its leaders, employees, volunteers, and agents from any claim that I or my child may have or that I may have against them as a result of injury or illness incurred during the course of participation in the activities. This release of liability shall include (without limitation) any claims of negligence or breach of warranty. This release of liability is also intended to cover all claims that members of the person’s or my family or estate, heirs, representatives, or assigns may have against this organization or its leaders, employees, volunteers, or agents.  I further agree to indemnify and hold harmless this organization and its leaders, employees, volunteers, or agents from any and all claims arising from my participation in its activities and programs, or as a result of injury or illness of the person(s) mentioned above during such activities.

First Aid and Emergency Medical Treatment

I recognize that there may be occasions where the person(s) named above may be in need of first aid or emergency medical treatment as a result of an accident, illness, or other health condition or injury. I do hereby give permission for agents of this organization to seek and secure any needed medical attention or treatment for the person(s) named above including hospitalization, if in the agent’s opinion such need arises. In doing so I agree to pay all fees and costs arising from this action to obtain medical treatment.

Release to use Image and Likeness

On occasion, Roll To Church, Inc. or its representatives takes photographs or makes an audio or videotape recording of children and/or adults involved in activities. Such photographs or video records may be used by staff and participants to remember the activities and participants. I consent to the use of any such audio or visual record of the person(s) named above to be used, distributed, or displayed as agents of the organization see fit. This consent includes but is not limited to: photographs, videotape, and audio recordings.

I represent that I am the person named above or that I am the parent/guardian of the person(s) named above, who is under 18 years of age. I have read the above Permission/Waiver Form and am fully familiar with the contents thereof. I give permission for the person(s) named above to participate in the activities of the Roll To Church, Inc. and their participating church, including any special events/activities described above. In consideration for allowing the participation of the person(s) named above in these activities, I hereby consent to the Permission/Waiver Form, including the Release of Liability above, on behalf of the person(s) named above and agree that this Permission/Waiver Form shall be binding upon me, my family, heirs, legal representatives, successors, and assigns.