FCCH Youth Waiver 2025-2026 - First Congregational Church of Hamilton

General Waiver

IN CONSIDERATION of my child being given the opportunity to participate in any activity related in any way to First Congregational Church of Hamilton (“FCCH”), including, but not limited to, FCCH Youth Ministry events, FCCH youth groups, activities at special events for which FCCH participates, such as, but not limited to Youth Retreats, Sky Zone, Laser Quest Event, Broom Hockey, 5th and 6th Grade Bash, Tuesday Meet-Ups, Explore, international travel, short term missions trips, indoor and/or outdoor games, swimming, vehicular transportation, air transportation, any other transportation, boating, frisbee, drama, ropes courses, zip lines, climbing walls, ball games, camp fires, walking, running, hiking, jumping, climbing, archery, shooting range, baseball, basketball, soccer, volleyball, other sports, fishing, golfing, bounce house, carpentry, dance, knitting, painting, rocket building or any other activity connected with or associated in any way with FCCH, including any risk of harm resulting there from (here after "Activities") I, for my child and for myself and his/her parents, personal representatives, assigns, heirs, and next of kin (“Releasors”) state and agree as follows:

I UNDERSTAND, ACKNOWLEDGE, AND HAVE BEEN FULLY INFORMED (a) that the Activities involve the risk of serious injury including permanent disability, paralysis, and death, and/or property damage (the “Risks”); (b) these Risks and dangers may be caused by my child’s own actions, or inactions, the actions or inactions of others participating in the Activities, the conditions in which the Activities take place, or the negligence of the Releasees named below; and, (c) there may be other risks and social and economic losses either not known to me or not readily foreseeable at this time that may result as a direct or indirect result of the Activities; and I FULLY ACCEPT AND ASSUME ALL SUCH RISKS AND ALL RESPONSIBILITY FOR LOSSES, COSTS, AND DAMAGES I and my child may incur directly or indirectly as a result of his/her participation in the Activities. The undersigned also expressly acknowledges that injuries received may be
compounded or increased by negligent rescue operations or procedures of the Releasees.

I HEREBY RELEASE, WAIVE, DISCHARGE AND COVENANT NOT TO SUE (a) FCCH and/or its staff, members, trustees, administrators, directors, employees, workers, volunteers, agents, officers, counselors, instructors, rescue personnel, (b) the owners and lessees of premises used to conduct the Activities, (c) the owners and lessees of equipment used in the Activities, or (d) other participants, campers, or persons involved in the Activities, all of whom for the purposes herein are referenced to as "Releasees," from all liability to the child named below, to me, to the child’s parents or next of kin, personal representatives, assigns, heirs, for any and all loss or damage, and any claim or demands therefore on account of injury to the person or property or resulting in the death of the child arising out of or related directly or indirectly to the Activities, whether caused by the negligence of the Releasees or otherwise, including negligent rescue operations. I FURTHER AGREE that if, despite this release and waiver of liability, assumption of risk, and indemnity
agreement, I, or anyone on my or the child’s behalf, makes a claim against any of the Releasees, I WILL INDEMNIFY, SAVE AND HOLD HARMLESS each of the Releasees from any litigation expenses, attorney fees, loss, liability, damage, or cost which may incur as a result of such claim, whether the claim is alleged to
have been caused by the negligence of the Releasees or otherwise. Further, any claims or disputes relating to the child’s participating in the Activities shall be venued in the Essex County Superior Court in the Commonwealth of Massachusetts, and that Massachusetts law shall govern this agreement.

I HEREBY GRANT PERMISSION for the child to participate in the Activities, and represent that the child is qualified, in good health, in proper physical condition, and of reasonable age and maturity to participate in such Activities.
I HEREBY GRANT PERMISSION for a licensed physician or other person, chosen by the leadership of First Congregation Church of Hamilton, to provide any medical emergency treatment necessary to my child[ren]. I will assume the liability for any resulting costs not covered by my health insurance.
I HEREBY AGREE that I, as the undersigned parent or legal guardian of the child or children identified below, am and will be fully responsible to pay for any damage to the real or personal property of FCCH or to any other person participating in or related to the Activities, which damage is caused by the negligent or intentional acts of my child[ren].

I HAVE READ THIS RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND HAVE SIGNED FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT, ASSURANCE OR GUARANTEE BEING MADE TO ME AND INTEND MY SIGNATURE TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY AND AN ASSUMPTION OF THE DUTY TO INDEMNIFY TO THE GREATEST EXTENT ALLOWED BY LAW. I UNDERSTAND THAT I HAVE THE RIGHT TO CONSULT WITH AN ATTORNEY PRIOR TO SIGNING BELOW REGARDING THE LEGAL IMPLICATIONS OF THIS WAIVER. I UNDERSTAND THAT THIS RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT REMAINS VALID UNTIL MY CHILD REACHES EIGHTEEN YEARS OF AGE.

Parent/Guardian Signature - General *

Date *

Child's Name *

Child's Age *

Parent/Guardian Information

Address *

Permission to Use Photograph of Child

Check for permission for photo release

I hereby grant FCCH permission to use, reproduce, publish or distribute any photographs, films, videotapes and/or sound recordings of my child for use in materials, publications, or other documents, including but not limited to social media accounts, websites, programs, or marketing material, it or they may create, without compensation to me or my child(ren), acknowledging that FCCH will not publish my child’s name and will only select photographs with two or more people included in the photograph.

Check for permission to take a photo for internal use

I hereby grant permission to FCCH to take and use a photograph of my child solely for the church's private, non-public database. The use of the photograph is strictly limited to internal identification and record‑keeping, and the image will not be published, shared, or otherwise disseminated publicly.

I do not consent to the use of my child's photo

I do not give permission for my child's photo to be taken or used for any purpose.

Parent/Guardian Signature - Photo Release *

Health Waiver

I give consent for my child to be given the following *nonprescription medication during any FCCH Youth Ministries event or trip sponsored by FCCH from September 1, 2024 through August 31, 2025. In the event that he/she is sick/injured while under the care of FCCH Youth Ministries and its representatives, I hereby consent to and will be responsible for any reasonable non-prescription medication as deemed helpful by a staff or lay leader. I further agree to hold FCCH and its representatives free and harmless of any claims, demands, or suits for damages arising for the authorization and provision of such medication. I understand that students are not permitted to self-medicate at FCCH events and trips and will provide all Rx and non prescription medications to a leader upon arrival at each event.

Student Information

Name *

Phone number *

Grade *

Date of Birth *

Primary Residence Home Phone Number

Address *

Parent/Guardian #1 Phone *

Parent/Guardian #1 Email *

Parent/Guardian #2 Phone

Parent/Guardian #2 Email

Primary Physician *

Physician Phone *

Emergency Contact *

Emergency Contact Phone Number *

Insurance Name *

Insurance Card # *

Picture of Front of Insurance Card *

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Picture of Back of Insurance Card *

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Current Health Conditions Requiring Emergency Care (select all that apply)

Food Allergies

Drug Allergies

Glasses/Contacts

Glasses

Contacts

Date of Last Tetanus Shot

Medications *

Over the Counter Medications (administered as needed, select to signify permission to dispense)

Advil/Motrin/Ibuprofen

Tylenol/Acetaminophen

Benadryl

Tums/Pepto-Bismol

Throat Lozenges/Cough Drops

Parent/Guardian Signature *

Date

Additional Medical Forms

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Household members