envision release of liability form
INTRODUCTION By signing below, I am agreeing to release the Urban Light / D.B.A Envision Miami (UL/EM) and other parties from liability. I am also granting permission to UL/EC to seek and obtain medical care in the event of my illness or injury. I have therefore been advised to read this document carefully and understand that I have the opportunity to consult with an attorney before signing. I understand that participation in this trip is a privilege. I am signing this Release of Liability and the attached Authorization for Emergency Medical Care (for minors) form in consideration for that privilege. I acknowledge that my participation in this trip may involve risks of physical injury, illness, or death, including risks of which I may not presently be aware, and I hereby agree to assume such risks.
RELEASE AND INDEMNIFICATION I hereby agree to release and hold harmless UL/EM, members of its board of directors, and its officers, employees, members, volunteers, and agents and sponsoring church (collectively, the “Released Parties”) from, and to discharge and waive, any and all claims, demands, losses, damages and liabilities described therein, whether known or unknown, foreseen or unforeseen, future or contingent, except claims, demands, losses, damages and liabilities arising out of the sole and exclusive gross negligence or willful misconduct of one or more of the Released Parties. I further covenant not to sue any of the Released Parties in connection with any of the claims, demands, losses, damages or liabilities described above. I further agree to indemnify, save and hold harmless the Released Parties from any and all claims, demands, losses, damages or liabilities for indemnities, contribution or otherwise with respect to any and all property damage, personal injury and/or death arising from my participation in UL/EC, as may be asserted by a third party (defined as any party other than the Released Parties or me), except to the extent such a claim might be based upon the sole and exclusive gross negligence or willful misconduct of one or more of the Released Parties.
AUTHORIZATION OF MEDICAL CARE I attest and certify that I have no known medical conditions that would prevent me from participating. I understand and acknowledge that UL/EM, together with the sponsoring church, provides foreign trip insurance coverage as a part of the cost of the trip. I understand and acknowledge that the provided coverage is not intended to take the place of a personal or group health insurance plan and may not specifically apply in every event of my illness, injury, death, or damage to my property that may occur during participation on this trip. I hereby certify that I am covered by a personal or group insurance plan, which I will carry on my person or with my team leader for the duration of the trip, to have in case of hospitalization and medical expenses beyond the coverage provided by the foreign trip insurance coverage noted above. In case I am in need of any necessary medical or surgical treatment to protect my health and welfare while participating in this trip, I authorize and agree to allow any authorized agent or employee of UL/EM to consent to and authorize the administering of such necessary medical and/ or surgical treatment. ‘In the case of a minor, in attached Authorization for Emergency Medical Care form, I have provided essential information, including personal health information. I authorize the release of this information when needed for the administration of such necessary medical and/or surgical treatment. I acknowledge and agree that the release of liability, hold harmless, and indemnification provisions set forth in Section 2 above shall apply to any authorization and consent to medical or surgical treatment on my behalf made by UL/EM or its authorized agents or employees. If I am a minor, I under- stand that efforts will be made to contact my parent/guardian before these actions are taken.
MEDIATION/ARBITRATION UL/EM and I agree that should a claim or dispute arise from my participation in this trip, it shall be settled by biblically based mediation and, if necessary, legally binding arbitration under a Christian mediation or reconciliation process in accordance with the Rules of Procedure promulgated by Peacemakers Ministries, Inc. of Colorado Springs, Colorado, United States of America, or its successor. The venue for such mediation or conciliation process shall be Miami, Florida, or such other location agreed upon by both parties. Judgment upon an arbitration award may be entered in any court otherwise having jurisdiction.
MISCELLANEOUS I expressly waive any defense to the enforcement of any provision of this Release arising from a claim of lack of consideration. In the event that any provision of this Release is determined to be invalid or unenforceable, the remainder of the provisions shall remain in full force and effect as if this Release had been executed with the invalid provision eliminated. I understand and agree that this Release is intended to be as broad and inclusive as permitted under applicable law. The undertakings and covenants of this Release shall be binding upon me, my family, my heirs, next of kin, legal representatives, beneficiaries, successors, and assigns. This Release shall be interpreted in accordance with the laws of the State of Florida The terms of this Release are contractually binding and are not a mere recital. This Release shall be effective and binding upon me. I have read this Release and understand its terms. I further represent that I am at least eighteen (18) years of age and am not a minor in my State of residence or, if I am a minor in such State, that both of my parents or my legal guardian have signed this form in the “Consent” section below, acknowledging this Release and accepting its terms on my behalf.
PHOTO RELEASE I understand that from time to time UL/EM uses participants’ photo, video and audio recordings to publicize UL/EM programs. Therefore, I hereby authorize UL/EM to use my likeness in the form of photograph, video, or audio recording, for any and all UL/EM printed or digital publications. I understand and agree that my likeness in the form of photograph, video, or audio recording will become property of UL/EM and will not be returned. I waive any compensation, and irrevocably authorize UL/EM to edit, alter, exhibit, publish and distribute my likeness for such purposes. I waive the right to inspect or approve the final product. I hereby hold harmless and release and forever discharge UL/EM from all claims, demands, and causes of action which I or any other person acting on my behalf have by reason of this release and authorization.
COVID I release and hold harmless Envision Miami dba. Urban Light, its directors, associates, employees, members and volunteers from and against any claim(s) for damages and/or injury or sickness of any nature arising from, during or pertaining to participation of myself and my family in any activity sponsored or sanctioned by Envision Miami dba. Urban Light/ The Christian and Missionary Alliance. Each participant must assume the risk of physical injury or sickness that could result from any of the activities, classes or events hosted by the aforementioned organization. Therefore I, release Envision Miami dba. Urban Light/ C&MA and its directors and volunteers from all liability for any injury or sickness to myself, my family or dependents, as a result of participating in any activities, classes or events hosted by the aforementioned organization. By signing the Envision Miami Waiver of Liability, I am stating I have read, understand and agree to the conditions of this Envision Miami Waiver of Liability. This signed agreement will be kept on file at the Envision Miami campus at 777 NW 106th St, Miami, FL 33150.
IF 18 AND UNDER THE BELOW PARENT/LEGAL GUARDIAN MUST SIGN! LEGAL GUARDIAN CONSENT AND ACCEPTANCE OF RELEASE ON BEHALF OF MINOR PARTICIPANT (FOR USE ONLY IF PARTICIPANT IS A MINOR)