Assumption of Risk, Release, and Indemnity Agreement
Assumption of Risk, Release, and Indemnity Agreement
Chi Alpha Reach the U Event (“Event”)
June 12-17, 2022
We want to acquaint you with the philosophy and expectations of The General Council of the Assemblies of God (“GCAG”). We also want to give you the opportunity to fully evaluate the undeniable fact that times of extreme stress and crisis will come that could cause you to question whether or not you would have participated in the Event if you had known all the facts. It is impossible to predict, fully prepare you, or furnish you with all aspects of what you may face. We have, therefore, prepared some basic assumptions which we both must make. Any adult participating is required by GCAG to complete this form, sign it, and return to Chi Alpha in order to participate.
(Please Print Legibly)
Name of Participant: Email:
Name of Emergency Contact:
Daytime Phone: Evening Phone:
Detailed Description of Activities:
Activities will take place June 12-17, 2022 at Evangel University, and surrounding areas in Springfield, Missouri. Activities include but are not limited to:
Risks of the above-listed activities include, but are not limited to:
Bruising, muscle strain or sprain, cuts, fractures, rotator cuff or other shoulder injuries, tendonitis, being hit by flying objects. Bites from insects, ticks, mosquitos, spiders, and/or snakes.
Transportation (as of this date), Subject to Change:
No transportation will be provided for participants. Each participant is personally responsible for transportation to and from the event and activities.
WARNING REGARDING COVID-19
I acknowledge the contagious nature of the Coronavirus/COVID-19 and that the CDC and many other public health authorities recommend practicing social distancing. I further acknowledge that the GCAG has put in place preventative measures to reduce the spread of the Coronavirus/COVID-19. I further acknowledge that the GCAG cannot guarantee that I will not become infected with the Coronavirus/Covid-19. I understand that the risk of becoming exposed to and infected by the Coronavirus/COVID-19 may result from the actions, omissions, or negligence of myself and others, including, but not limited to, the GCAG and its employees and staff. I voluntarily seek to participate in the above event and acknowledge that I am increasing my risk of exposure to the Coronavirus/COVID-19. I acknowledge that I am solely responsible for compliance with all applicable precautionary measures of my state and local health agencies, and the CDC.
Under Missouri law, any individual entering the premises or engaging in the services of the business waives all civil liability against the individual or entity for any damages based on inherent risks associated with an exposure or potential exposure to COVID-19, except for recklessness or willful misconduct.
I attest that:
I, IN CONSIDERATION of my acceptance as a participant of this event in cooperation with the Assemblies of God, and other considerations the sufficiency of which is acknowledged, represent and agree that:
I am not traveling as an employee of the General Council of the Assemblies of God.
I attest and certify that I am physically fit and have no medical conditions that would prevent me from participating in the above-referenced activity.
I am aware of the hazards and risks to my person and property associated with participating in the above event and activities, such hazards and risks including but not being limited to injury; increased stress; accident; disease (including Coronavirus/COVID-19); inadequate medical services and supplies; death; criminal acts; natural disasters; weather conditions; risks of traveling to or from destinations. I recognize that I may be subjected to potential risks, illnesses, injuries, and even death. I have made my own investigation of these risks, understand these risks, and assume them knowingly and willingly.
I also acknowledge that in working, living, and traveling in cities, I may experience problems associated with urban living, including increased crime, pollution, high population density or standards of living, and health standards that are different from those to which I am accustomed. I acknowledge that it is my responsibility to take every precaution to safeguard my health and to protect my personal belongings from damage or theft. I acknowledge that GCAG recommends that I never travel alone, particularly at night. Being alone, especially at night, may present additional danger to my safety and well-being.
I understand and agree that if during my participation in the above-described activities, the travel leader learns that I am experiencing serious health problems, have suffered an injury, or am otherwise in a situation that raises significant health and safety concerns, then the travel leader may contact the person whose name I have provided as my "emergency contact." I understand that the travel leader ordinarily will not initiate such contact without first having a discussion with me.
KNOWING THE RISKS DESCRIBED ABOVE, I AGREE, ON BEHALF OF MY FAMILY, HEIRS, AND PERSONAL REPRESENTATIVES, TO ASSUME ALL THE RISKS AND RESPONSIBILITIES SURROUNDING MY PARTICIPATION IN THE ABOVE-DESCRIBED ACTIVITIES, BOTH KNOWN AND UNKNOWN. TO THE MAXIMUM EXTENT ALLOWED BY LAW, I RELEASE, HOLD HARMLESS, AND AGREE TO INDEMNIFY THE GENERAL COUNCIL OF THE ASSEMBLIES OF GOD, AND ITS AFFILIATED MINISTRIES, ANY ASSEMBLIES OF GOD CHURCH AND/OR DISTRICT COUNCIL, AND ANY ASSEMBLIES OF GOD SCHOOL, COLLEGE OR UNIVERSITY, AND THEIR OFFICERS, DIRECTORS, EMPLOYEES, VOLUNTEERS, AND AGENTS, FROM AND AGAINST ANY PRESENT OR FUTURE CLAIMS, LOSSES, LIABILITIES, COSTS, AND EXPENSES FOR INJURY TO PERSON OR PROPERTY, OR FOR ANY OTHER DAMAGE, WHICH I MAY SUFFER, OR FOR WHICH I MAY BE LIABLE TO ANY OTHER PERSON, RELATED TO MY PARTICIPATING IN SAID ACTIVITIES RESULTING FROM ANY CAUSE, INCLUDING BUT NOT LIMITED TO NEGLIGENCE ON MY PART OR ON THE PART OF ANY OF THE RELEASED PARTIES; PROVIDED THAT THIS RELEASE OF LIABILITY SHALL NOT APPLY TO GROSS NEGLIGENCE OR WILLFUL OR WANTON MISCONDUCT.
I understand I am responsible for obtaining any insurance coverages that I consider necessary.
I certify that I am age 18 or older. I understand and agree that no oral or written representations can or will alter the contents of this document. This Agreement shall be governed and construed in accordance with the laws of the State of Missouri, excluding its choice of law rules, and all claims relating to or arising out of this Agreement, including claims for injuries or wrongful death in any way related to the above-described activities, shall likewise be governed by the laws of the State of Missouri, excluding its choice of law rules.
Participant Printed Name
January 28, 2023
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Document Name: Assumption of Risk, Release, and Indemnity Agreement
Agree & Sign