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Liability Release Form

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In consideration for being accepted by the MacPherson Institute for participation in the 2010-2011 school year, we (I), being 21 years of age or older, do for ourselves (myself) (and on behalf of my child-participant if said child is not 21 years of age or older) do hereby release, forever discharge and agree to hold harmless the MacPherson Institute, the board of directors, Southern Heights Baptist Church and the staff thereof from any and all liability, claims or demands for personal injury, sickness, or death, as well as property damage and expenses of any nature whatsoever which may be incurred by the undersigned and the child participant that occur while said child is participating in the above-described program and any activities pertaining to the school year or the school.

Furthermore, we (I) [and on behalf of our (my) child-participant if under 21 years] hereby assume all risk of personal injury, sickness, death, damage and expense as a result of participation in school, recreation, clubs and work activities therein.

Further, authorization and permission is hereby given to MacPherson Institute to furnish any necessary transportation, food, or emergency care for this participant.

The undersigned thereby agree to hold harmless and indemnify said school, its administrators, employees, or Southern Heights Baptist Church for any liability sustained by said initiative as the result of the negligent, willful or intentional acts of said participant, including expenses incurred attendant hereto.

(If the participant has not attained the age of 21 years):

We (I) are the parent(s) or legal guardian(s) of this participant and hereby grant our (my) permission for him (her) to participate fully in said program, and hereby give our (my) permission to take said participant to a doctor or hospital or other medical facility and hereby authorize medical treatment including but not limited to emergency surgery or medical treatment, and assume the responsibility of all medical bills, if any.

Further, should it be necessary for the participant to return home due to medical reasons, disciplinary action or otherwise, we (I) hereby assume all transportation cost.

(Only participant need sign if 21 years of age or older. If under 21, both parents must sign unless parents are separated or divorced in which case the custodial parent must sign.)

Download the Liability Release Form (WordPad)

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