MBR i-Go Liability Waiver / Rental Agreement

Participant's Name*

First NameLast Name

In consideration of allowing me/my child to participate in the 12-21 program I agree to release and hold harmless First Fruits of Zion, Vine of David, and 12-21—its officers, agents, employees, and volunteers—from any liability or responsibility for bodily injury, damage, or illness to the above identified child while participating in any athletic or social activity that may directly or indirectly be sponsored by First Fruits of Zion, Vine of David, or 12-21 programming, except for any intentional act or reckless disregard. Further, I agree to indemnify and hold harmless First Fruits of Zion, Vine of David, or 12-21 programming—its officers, employees, and agents—with respect to any claim asserted by or on behalf of my child as a result of bodily injury, illness, or damage, except for any intentional act or reckless disregard.

I agree on behalf of myself, my child’s other parent or guardian, my child named herein, or our heirs or successors, and assign to release, waive, indemnify, and hold harmless First Fruits of Zion, Vine of David, 12-21 and their employees, volunteers, or other agents with respect to any and all actions, claims, or demands that may be made or brought against them, except for any intentional act or reckless disregard.

No weapons, tobacco products, drugs, or alcohol are allowed at 12-21 events.

RELEASE: I hereby warrant and grant to 12-21 Initiative the right and permission to use and publish the photographs/film/videotapes/ electronic representations and/or sound recordings made of me or my child at all 12-21 activities, and I hereby release 12-21 and all employees, volunteers, related parties, or other organizations associated with the activity from any and all liability from such use and publication. I hereby authorize the reproduction, copyright, exhibit, broadcast, electronic storage, and/or distribution of said photographs/ film/videotapes/electronic representations and/or sound recordings without limitation at the discretion of 12-21 Initiative.

MEDICAL: I hereby warrant that to the best of my knowledge, my child is in good health, and I assume all responsibility for the health of my child. I acknowledge that a current Medical Consent Form is on file with 12-21.

LOST OR STOLEN ITEMS: The 12-21 program will not be held liable for any valuables lost or stolen at the event in which I/my child am/ is participating.

DRUGS OR TOBACCO PRODUCTS: The 12-21 program will not be held liable for any illegal use of drugs or tobacco products. Use of such products or illegal access will result in the participant being automatically sent home under our Zero Tolerance Policy.

ALCOHOL: The 12-21 program will not be held liable for any underage drinking or illegal access to alcohol during any of its events, on or off site. Underage drinking or illegal access to alcohol will result in the participant being automatically sent home under our Zero Tolerance Policy.

SEXUAL MISCONDUCT: The 12-21 program has a zero tolerance policy regarding sexual misconduct defined within the Zero Tolerance Policy Document. Any violations will be swiftly and legally dealt with. 12-21 will in no way be held accountable for the misconduct of any individual, rather the responsibility will lie fully and solely on the shoulders of the guilty party.

I understand and agree that this release is required as contractual consideration to the 12-21 program for allowing me/my child to participate in this youth ministry event, and that my agreeing to this release of liability is a required prerequisite in order for me/my child to participate in the applicable youth ministry event.

I will wear a properly strapped helmet when instructed to me by Camp Tzadi or Simpson Park staff:*

I will not enter the river at camp unless instructed by Camp Tzadi or Simpson Park staff and only with a life jacket on:*

I will not attempt to drive any vehicle at camp unless otherwise instructed to me by Camp Tzadi staff:*

I understand and I state that I am not under the influence of any intoxicating substance and will not consume any while at camp:*

The discipline system has been explained to me and I have agreed to it: (see parent and camper packets)*

I agree to be sent home upon receiving the fair amount of disciple slips: (see parent and camper packets)*

I will not engage in any sexual activity whatsoever at camp as defined by the relationship policy and Camp Tzadi rules (see parent and camper packets):*

I understand that I am responsible for my actions and that I will be held liable by law to any violations of the law while under the care of Camp Tzadi:*

I {Participant's Name} HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

FOR PARENTS/GUARDIANS OF PARTICIPANT OF MINOR AGE (UNDER AGE 18 AT TIME OF REGISTRATION)

This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree to his/her release as provided above of all the Releasees, and, for myself, my heirs, assigns, and next of kin, I release and agree to indemnify and hold harmless the Releasees from any and all liability incidents to my minor child’s involvement or participation in these programs as provided above, EVEN IF ARISING FROM THE NEGLIGENCE OF THE (RELEASEES), to the fullest extent permitted by law.

Participant Signature:*

12-21 Event Waiver & Release Form