Please complete one liability form for each child under 18.

Adults please complete the Over-18 Form.

This only needs to be completed once a year.

United In Him Liability, Media & Covid-19 Release Form

 

Student’s name  ________________________________  Student’s cell phone # ________________________   

Parent’s name:________________________________ Phone # _____________________________

Emergency Name & Number: _______________________________________________________________

I give permission for my child to be transported in the vehicles provided by United In Him. I do hereby release and agree to hold harmless United In Him, their members, and their volunteers from any and all liability claims or damages for personal injury, sickness or death as well as property damage and expenses of any nature whatsoever which may be incurred by the undersigned by participating in activities associated with United In Him and/or any person or organization they partner with.

 

Furthermore, I hereby assume all risk of personal injury, sickness, death, damage and expense as a result of participating in travel, recreation, and work activities involved therein. 

 

I, the undersigned, further hereby agree to hold harmless and not sue United In Him and/or any person or organization we partner with.its members or volunteers and/or any person or organization they partner with for any liability sustained as a result of negligent, willful, or intentional acts of said participant including expenses incurred attendant thereto.

 

 

MEDIA RELEASE - I, the undersigned, do hereby grant or deny permission to United In Him and/or other partners to use the image of myself or my child listed above. Such use includes the display, distribution, publication, transmission, or otherwise use of photographs, images and/or video taken of myself or my child for use in materials that include, but may not be limited to, printed materials such as brochures and newsletters, videos, and digital images such as but not limited to those on the United In Him social media pages.

 

COVID RELEASE: I understand the health risks associated with Covid-19 for my child participating in any activity with United In Him and agree to release and agree to hold harmless United In Him, their members, their volunteers and/or any person or organization they partner with form any and all liability claims or health issues associated with Covid-19.

 

 

Parent / Legal Guardian Signature_____________________________________   Date _________________

 

 

United In Him Covid-19 Policy: All persons shall sanitize their hands before entering the van and wear a mask covering their mouth and nose for the entire time in the van. While participating in activities, all persons shall either remain 6’ distance from one another or wear their mask properly if closer than 6 feet. The van will be properly sanitized after each use. All indoor activities will be properly sanitized during and after each activity.

United In Him Liability, Media & Covid-19 Release Form – Over 18

 

Name: _____________________________________________

Phone # _____________________________  Other contact (IG/FB): _________________________________

Emergency Name & Number: _________________________________________________________________

I give permission to be transported in the vehicles provided by United In Him. I do hereby release and agree to hold harmless United In Him, their members, and their volunteers from any and all liability claims or damages for personal injury, sickness or death as well as property damage and expenses of any nature whatsoever which may be incurred by the undersigned by participating in activities associated with United In Him and/or any person or organization they partner with.

 

Furthermore, I hereby assume all risk of personal injury, sickness, death, damage and expense as a result of participating in travel, recreation, and work activities involved therein. 

 

I, the undersigned, further hereby agree to hold harmless and not sue United In Him and/or any person or organization we partner with.its members or volunteers and/or any person or organization they partner with for any liability sustained as a result of negligent, willful, or intentional acts of said participant including expenses incurred attendant thereto.

 

 

MEDIA RELEASE - I, the undersigned, do hereby grant or deny permission to United In Him and/or other partners to use the image of myself. Such use includes the display, distribution, publication, transmission, or otherwise use of photographs, images and/or video taken of myself or my child for use in materials that include, but may not be limited to, printed materials such as brochures and newsletters, videos, and digital images such as but not limited to those on the United In Him social media pages.

 

COVID RELEASE: I understand the health risks associated with Covid-19 and participating in any activity with United In Him and agree to release and agree to hold harmless United In Him, their members, their volunteers and/or any person or organization they partner with form any and all liability claims or health issues associated with Covid-19.

 

 

Signature_____________________________________   Date _________________

 

 

United In Him Covid-19 Policy: All persons shall sanitize their hands before entering the van and wear a mask covering their mouth and nose for the entire time in the van. While participating in activities, all persons shall either remain 6’ distance from one another or wear their mask properly if closer than 6 feet. The van will be properly sanitized after each use. All indoor activities will be properly sanitized during and after each activity.

 

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