SSM Launch Box 2020
Stonebriar Community Church
Photo, Recording and Image Release (Minor)
For myself and for and on behalf of my child(ren) identified in this authorization (referred to as “Minor”), I hereby agree, represent and authorize as follows:
I grant Stonebriar Community Church, its successors, assigns and licensees (collectively, the “Church”) permission to use, reproduce, publish, broadcast, stream, and exhibit in any medium, the Minor’s portrait, photograph, image, voice, works of authorship, writings and statements in any form (collectively, the “Product”) which are created, captured or developed by or for the Church in connection with the Minor’s participation in Church events or activities.
I irrevocably authorize the Church to edit, alter, copy, exhibit, publish or distribute the Product in all forms and media or technology now known or hereafter developed and in all manners for advertising, publicity, commercial, promotion, trade, or other lawful purpose. I waive the right to inspect or approve the finished Product. I waive any right to royalties or other compensation related to the use of the Product.
I hereby hold harmless and fully release the Church, its agents, volunteers, licensees, employees, and representatives from all claims, demands, and causes of action that I and/or the Minor, or our respective heirs, representatives, executors, administrators, or any other persons acting on my behalf, the Minor’s behalf, or on behalf of our respective estates, have or may have due to this authorization or the Church’s use of the Product as permitted herein.
I am the parent and/or legal guardian of the Minor and that my parental and/or legal guardian rights include the ability to sign this agreement on behalf of the Minor. I give my consent and authorization without reservation to the terms herein on behalf of the Minor.
I am 18 years of age or older and am competent to contract in my own name. I read this agreement and release before signing and I fully understand its contents.
v.10.13.2018
Assumption of Risk, Voluntary Release, and Indemnity Agreement
In consideration for the undersigned or the undersigned’s dependent (referred to as “Participant”) being permitted to participate in the event(s) described on Exhibit A, as well as any future events to which the undersigned or other guardian of Participant consents, pursuant to and in conjunction with this Agreement (herein collectively and generally referred to as the “Ministry Event”), and any activities conducted during the Ministry Event, the undersigned (“I” or “Me”) agrees as follows:
1. ASSUMPTION OF RISK AND REPRESENTATION. I understand, am aware, and assume all risks inherent in Participant’s participation in the Ministry Event. The risks include those listed on Exhibit A, as well as those listed in future Ministry Event descriptions to which I, or other guardian of Participant, later consent, whether in conjunction with and as part of this Agreement or as part of a separate consent. The risks include, but are not limited to, the hazards of road transportation, service projects, construction projects, illness or accident without immediate access to medical facilities, and the forces of nature. Any of such activities may result in serious bodily injury or death. I represent that I (or Participant) possess the necessary skills and fitness to safely participate in the Ministry Event(s).
2. RELEASE, WAIVER, DISCHARGE AND COVENANT NOT TO SUE. I, on behalf of myself and Participant, and our respective personal representatives, assignees, insurers, heirs, executors, administrators, spouse and next of kin, hereby RELEASE, WAIVE, DISCHARGE AND COVENANT NOT TO SUE Stonebriar Community Church and its directors, officers, employees, agents, volunteers, as well as its/their successors, assigns, affiliates, subordinates, and subsidiaries (collectively referred to as the “Church”), and RELEASE, WAIVE AND DISCHARGE the Church from any and all liability for any and all loss, damage, injury, death, and expense to me or the Participant or his/her/our property, whether caused by negligence, or otherwise (except not for any gross negligence or willful misconduct on the part of the Church), while I am, or the Participant is, participating in a Ministry Event and any other activities in connection therewith or described herein.
3. INDEMNITY. I AGREE TO INDEMNIFY THE CHURCH FROM ANY LIABILITY, LOSS, DAMAGE OR COST THAT MAY BE INCURRED BY ME OR PARTICIPANT DUE TO PARTICIPATION IN THE MINISTRY EVENT, WHETHER CAUSED BY THE NEGLIGENCE OF THE CHURCH OR OTHERWISE (EXCEPT NOT WHERE CAUSED BY ANY GROSS NEGLIGENCE OR WILLFUL MISCONDUCT OF THE CHURCH). I, FOR MYSELF AND PARTICIPANT, ASSUME FULL RESPONSIBILITY FOR, AND RISK OF, BODILY INJURY, DEATH OR PROPERTY DAMAGE DUE TO THE NEGLIGENCE (BUT NOT FOR GROSS NEGLIGENCE OR WILLFUL MISCONDUCT) OF OTHER PARTICIPANTS IN THE MINISTRY EVENT, OR OTHERWISE, WHILE I OR PARTICIPANT PARTICIPATE IN THE MINISTRY EVENT.
4. ARBITRATION. Any dispute arising under or relating to this Agreement will be resolved through a mutually acceptable alternative dispute resolution process. If I, as the Participant or as parent/guardian of the Participant, and the Church, cannot agree upon such a process, the dispute shall be submitted exclusively to the mediation and arbitration procedures of the Institute for Christian Conciliation/Peacemaker Ministries (www.hispeace.org). Venue for such dispute resolution processes shall be exclusively in Collin County, Texas.
5. I agree that the provisions of this Agreement are intended to be as broad and inclusive as permitted by the laws of the State of Texas, and that, if any portion of this Agreement is held invalid, it is agreed that the balance, notwithstanding, shall continue in full legal force and effect. I further agree that:
a. I HAVE CAREFULLY READ THIS AGREEMENT.
b. THIS AGREEMENT APPLIES TO ALL CURRENT AND FUTURE MINISTRY EVENTS OF THE CHURCH WITHIN A TWO-YEAR PERIOD FROM THE DATE OF MY SIGNATURE HEREIN IN WHICH I, OR THE NAMED MINOR CHILD, PARTICIPATE AND THAT THE CHURCH MAY RELY ON THIS AGREEMENT UNLESS AND UNTIL THE CHURCH IS NOTIFIED OTHERWISE, IN WRITING. THIS RELEASE MUST BE RENEWED EVERY TWO (2) YEARS IF I, OR THE NAMED MINOR CHILD, WISH TO PARTICIPATE IN FUTURE MINISTRY EVENTS.
c. I UNDERSTAND THAT I AM AGREEING TO RELEASE AND INDEMNIFY THE CHURCH AS STATED ABOVE.
d. I CERTIFY THAT I AM EITHER (1) AT LEAST EIGHTEEN (18) YEARS OF AGE, OR (2) THE LEGAL GUARDIAN ACTING ON BEHALF OF THE PARTICIPANT WHO IS UNDER EIGHTEEN (18) YEARS OF AGE.
Consent for Treatment in Event of Accident/Injury
In the event of an accident or injury, I hereby give my permission for the physician/dentist selected by Stonebriar Community Church (SCC) to secure proper treatment for the above-listed person as deemed necessary. I also authorize SCC staff and volunteers to administer medical aid as required for injury in the event that I cannot immediately be contacted.
EXHIBIT "A"
STONEBRIAR COMMUNITY CHURCH STUDENT MINISTRY
TYPE OF EVENT: Mission Trip
VENUE NAME & ADDRESS: Hulen Street Church, 7100 S Hulen Street, Fort Worth, TX 76133
Non-exclusive list of planned activities for this event and a non-exclusive list of associated risk(s):
ACTIVITY
- Transportation
- Recreational Outdoor or Indoor Activities
- Cafeteria/Family Style Meals, Food items brought, prepared or purchased by students or SCC volunteers/staff, and misc. snacks served by Stonebriar Student Ministry and its participants.
- Evangelizing door to door
I agree and understand that the ASSUMPTION OF RISK, VOLUNTERY RELEASE, AND INDEMNITY AGREEMENT (the “Agreement”) that was signed by or for Participant and provided to and for the benefit of the Church fully applies, is incorporated herein by this reference, and is enforceable in regard to the above-referenced Event and all risks associated therewith. Without limiting the Agreement in any way, I, on behalf of myself and Participant, and our respective personal representatives, assignees, insurers, heirs, executors, administrators, spouse and next of kin, hereby RELEASE, WAIVE, DISCHARGE AND COVENANT NOT TO SUE Stonebriar Community Church and its directors, officers, employees, agents, volunteers, as well as its/their successors, assigns, affiliates, subordinates, and subsidiaries (collectively referred to as the “Church”), and RELEASE, WAIVE AND DISCHARGE the Church from any and all liability for any and all loss, damage, injury, death, and expense to me or the Participant or his/her/our property, whether caused by negligence or otherwise (except not for any gross negligence or willful misconduct on the part of the Church) while I am, or the Participant is, participating in a Ministry Event and any other activities in connection therewith or described herein.
Stonebriar Student Ministry Code of Conduct:
Our desire is that every person present at our programming would have a great experience and develop lasting and beneficial relationships with Christ and others. Our staff and ministry partners is committed to investing the time and personal attention to help our students and guests get the most out of their experience. With that in mind we ask that you:
- Respect of the people around you, the property we are at and the purpose of the event
- Follow the event schedule and be on time and involved in the activities at hand.
- Do not isolate yourself or others at any time. If you must leave the activity, inform an adult on our staff before you go.
- Be aware of where you are and who is around you always and take action to keep yourself and others safe.
- When behaviors and attitudes that are disrespectful, dishonest, disobedient or disruptive to the event occur and the individual (s) are not responsive to graceful coaching, they can be sent home at the staff’s discretion and the family’s expense.