Adult Medical Hold Harmless Form
Medical Hold Harmless Forms provide insurance and legal information in case of an emergency, and is required for kids, students and adults to participate in certain activities at Fairhaven Church. The Seizures form should be used for any person participating in events that have any medical conditions such as seizures. The form is valid for one year. If something isn't applicable please use N/A.
A copy of this release may be used as if it were an original.
Participants Information
Emergency Contact
Medical Treatment Release Statement
The undersigned partipipant named below grant(s) permission to Fairhaven Church, including any of its officers, directors, employees, agents or representatives (collectively, the “Church”) to take any actions it determines are reasonably necessary, including seeking medical treatment, for the purposes of maintaining my health and well-being, in the event of a medical situation or emergency. In such an event, the Church shall endeavor to contact the undersigned spouse and emergency contact (if provided) as promptly as possible. By signing this document, I have agreed to the above terms.
Allergies & Medication
Allergies and Medication is required.
Liability Release Statement
The undersigned participant named below acknowledges the participation in a Ministry activity (the “Activity”) sponsored by Fairhaven Church (the “Church”). Further, the undersigned participant: (1) release, waive, and forever discharge the Church and any of its officers, directors, employees, agents or representatives (collectively, “Representatives”) from all actions, claims, costs, expenses, liability, or demands arising from or in any way related to the participation in the Activity; (2) and shall also agree to indemnify and hold the Church and its Representatives harmless from any and all claims, actions, suits, procedures, costs, expenses, damages and liabilities, including attorney’s fees, arising out of their involvement in the Activity, and to reimburse the Church or its Representatives, as the case may be, for any such expenses incurred related to the same.
Photograph Release Statement
Fairhaven Church has my permission to use my photograph, video and audio recordings, likeness, artwork and/or story in any current or future publications, videos, web pages and any other promotional materials produced, used by and representing Fairhaven Church. I understand the circulation of the materials could be worldwide and that there will be no compensation to me for this use. By signing this document, I have agreed to the above terms.