When you are done click the "SUBMIT" button at the bottom of the form.
Read the following information and check the box to indicate your agreement. If participant is under 18 years of age the parent or guardian must agree.
1) If I am incapacitated for any reason while participating in this even, I authorize an adult to provide emergency first aid and consent to ambulance, paramedic, x-ray examination, anesthetic, medical, surgical or dental diagnosis or treatment and hospital care to be rendered to me under the general or special supervision and on the advice of any physician or dentist licensed under the provisions of the Medical Practice Acts or on the medical staff of a licensed hospital, whether such diagnosis or treatment is rendered at the office of said physician or at said hospital.
2) I agree to be liable for and pay all costs and expenses incurred in connection with such ambulance, medical, dental and hospital services rendered to me pursuant to this authorization. If it is necessary for me to return home due to medical or other reasons, I agree to pay for all transportation costs.
3) I give permission for still or moving images of me to be used for promotional purposes in printed and/or electronic media.
4) I understand there are risks of bodily injury, disability, paralysis and/or death and damage to property in any event that involves travel or other activities. I agree to assume and incur all the risks that may be encountered by me and to my property in this event and all related activities to the extent permitted under Indiana law.
5) I agree to release and hold harmless Castleview Baptist Church and their members, employees, volunteers and agents from all liability, actions, causes of actions, claims, expenses and damages on account of their negligence which results in injury to, or death of, me or damage to my property, which I now have or which may arise in the future in connection with this event and all related activities to the extent permitted under Indiana law.