MEDICAL CONSENT AND LIABILITY AND ACTIVITY RELEASE FORM
Calvary Lutheran School Run, Walk, Ride, INDIANAPOLIS, IN
I understand that the activity for which this Medical Consent and Liability and Activity Release Form is being given is described as follows: An occasion to engage in social, physical, and emotional activities at Calvary Lutheran School of Indianapolis.
I hereby consent to the participation of myself (or my child) in the above-described activity. I have read the informational materials regarding the planned activities. I am aware that the participant agrees to participate in various activities that may involve additional risks, such as running, walking, and riding his/her bicycle.
I understand that I have a duty to provide primary accident and medical insurance for myself (or for my child) and I declare that I am (or my child is) covered by primary accident and medical insurance.
I RELEASE AND FOREVER DISCHARGE, CALVARY EVANGELICAL LUTHERAN CHURCH, THEIR AGENTS AND SERVANTS, SUCCESSORS AND ASSIGNS, DIRECTORS, TRUSTEES, OFFICERS, EMPLOYEES, AND OTHER REPRESENTATIVES FROM ANY AND ALL DAMAGES AND CAUSES OF ACTION EITHER AT LAW OR IN EQUITY THAT I MAY HAVE AS A RESULT OF MY (OR MY CHILD’S) PARTICIPATION IN, ATTENDANCE AT, AND TRAVEL TO AND FROM THE SERVANT EVENT. FURTHERMORE, I DO HEREBY EXPRESSLY STIPULATE, AND AGREE TO INDEMNIFY AND HOLD FOREVER HARMLESS , CALVARY EVANGELICAL LUTHERAN CHURCH, ITS AGENTS AND SERVANTS, SUCCESSORS AND ASSIGNS, DIRECTORS TRUSTEE, OFFICERS, EMPLOYEES, AND OTHER REPRESENTATIVES AGAINST LOSS FROM ANY AND ALL PRESENT OR FUTURE CLAIMS, DEMANDS OR ACTIONS IN LAW OR IN EQUITY THAT MAY HEREAFTER BE MADE OR BROUGHT BY ME OR MY CHILD, BY ANYONE ON BEHALF OF ME OR MY CHILD, OR BY ANYONE ELSE ON THEIR OWN BEHALF FOR DAMAGES OR ANY OTHER LEGAL OR EQUITABLE REMEDY ON ACCOUNT OF ANY INJURY, ILLNESS, PHYSICAL CONDITION, INCONVENIENCE OR LOSS SUSTAINED BY ME OR MY CHILD DURING THE EVENT OR TRAVEL TO AND FROM THE SAME.
I, the undersigned, hereby acknowledge that I have read the forgoing, understand its contents, and have signed the same as my own free act and deed.