VICTORY CHURCH - PARTICIPATION AGREEMENT

Name of Event *

Date(s) of Event *

Location(s) of Event *

PERSONAL INFORMATION

* If this is a family event, please use your name and contact information below.

Participants First Name *

Participants Last Name *

Street Address *

City *

State *

Zip Code *

Email Address *

Is the Participant under 18 years of age? *

Yes	No
This is a family event

EMERGENCY & MEDICAL INFORMATION

Emergency Contact Name *

Emergency Contact Phone *

Are there any specific or special medical needs that we should be aware of for you/participant? *

Yes

No

Medical Needs: Please list any special needs below, along with any information that could be helpful. *

If needed, is church staff or ERT volunteer team allowed to administer medical treatment to you/participant (with limited knowledge) until professional help is available? *

Yes

No

Are you/participant covered by personal/family medical insurance? *

Yes

No

Name of Insuer *

Policy or Group Number *

PHOTOGRAHY & VIDEO RELEASE

I, the participant or parent/legal guardian, grant permission to Victory Church and its representatives, the irrevocable and unrestricted right to reproduce the photographs and/or video images taken of myself or my child for the purpose of publication, promotion, illustration, advertising, or trade, in any manner or in any medium, including internet-based. I hereby release Victory Church and its legal representatives for all claims and liability relating to said images or video. Furthermore, I grant permission to use my or my child’s statements that were given during an interview, with or without his/her name, for the purpose of advertising and publicity without restriction. I waive my or my child’s right to any compensation. All prints, videos, and digital reproductions shall be the property of Victory Church.

* Please note, photos/videos may or may not be taken at this specific event.

I have read and agree to the above Photography & Video Release *

Yes, I agree

No, do not use mine or my child's photo/video

PARTICIPATION AGREEMENT

I acknowledge that participation in the activity described above involves risk to the Participant (and Participant's parents or guardians, if Participant is a minor), and may result in various types of injury including, but not limited to, the following: sickness,bodily injury, death, emotional injury, personal injury, property damage and financial damage.

In consideration for the opportunity to participate in the activity described above (the "Activity"). The Participant (or parent/guardian if Participant is a minor- under 18 years of age) acknowledges and accepts the risks of injury of injury associated with Participation in and transportation to and from the Activity. The Participant (or parent/guardian accepts personal financial responsibility for any injury or other loss sustained during the activity or during transportation to and from the activity, as well as for any medical treatment rendered to the Participant that is authorized by the sponsor or its agents, employees, Volunteers, or any other representatives (collectively referred to hereinafter as the "Activity Sponsor "). Further, the Participant (or parent/Guardian) releases and promises to indemnify, defend and hold harmless the Activity Sponsor for any injury arising directly or indirectly out of the described Activity or transportation to and from the Activity, whether such injury arises out of the negligence of the Activity Sponsor, the Participant or otherwise.

If a dispute over this agreement or any claim for damages arises, the Participant (or parent/guardian) agrees to resolve the matter through a mutually acceptable alternative dispute resolution process. If the Participant (or parent/guardian) and the Activity Sponsor cannot agree upon such a process, the dispute will be submitted to a three-member arbitration panel for resolution pursuant to the rules of the American
Arbitration Association.

I have read and agree to the above Participation Agreement. *

Participation Agreement

Revised 02.03.25