Name

I acknowledge that my participation, or any family member’s participation, in any Mission Hills ministry is voluntary and may require involvement in activities that require traveling or physical exertion and may present risks that could result in property damage, bodily injury, or even death. By signing this form, I agree Mission Hills Church is not responsible for personal belongings; I consent to photos being taking during Tuesday night or social activities that may be used in our promotion and communications. I realize that contact with someone from this group could result in emotional or physical harm. I hereby take the following action for myself, my executors, administrators, heirs, next of kin, successors, and assigns: a) I waive, release, and discharge from any and all claims or liabilities for death or personal injury damages of any kind, which arise out of or relate to my participation in Mission Hills Church activities, the following person or entities: Mission Hills Church, its Senior Pastor, Associate Pastors, Program Staff, Elders, employees, volunteers, representatives, subcontractors, and agents of any of the above; b) I agree not to sue any of the persons or entities mentioned above for any of the claims or liabilities that I have waived, released, or discharged herein; and c) I indemnify and hold harmless the persons or entities mentioned above from any claims made or liabilities assessed against them as a result of my actions. I hereby assume the risks of participating. I agree to indemnify and hold harmless the persons or entities mentioned above for any claims or liabilities assessed against them as a result of any insufficiency of my legal capacity or authority to act. I hereby authorize any licensed physician, emergency medical technician, hospital or other medical or health care facility to treat me herein for the purpose of attempting to treat or relieve any injury I may receive. I authorize any such Medical Provider to perform all procedures deemed medically advisable in attempting to treat or relieve any such injuries. I consent to the administration of anesthesia as deemed advisable. I realize and appreciate that there is a possibility of complications and unforeseen consequences in any medical treatment, and I assume any such risk for and on behalf of myself and said minor. I further agree to pay all charges for any needed dental, medical, or hospital care or treatment.