HOPE HOUSE ACCIDENT WAIVER AND RELEASE OF LIABILITY FORM
I HEREBY ASSUME ALL OF THE RISKS OF PARTICIPATING IN HOPE HOUSE’s residential housing program, including any risks that may arise. I certify that I am physically/mentally fit and have not been advised to not participate by a qualified medical professional. I certify that there are no health related reasons or problems which preclude my participation in this program and its activities. I acknowledge that this “Accident Waiver and Release of Liability Form” will be used by Hope House, and that it will govern my actions and responsibilities while a participant of the program.
In consideration of my application/enrollment and permitting me to participate in this program, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors, and assigns as follows: (A) I WAIVE, RELEASE, AND DISCHARGE from any and all liability, including but not limited to, liability arising from the negligence or fault of the entities or persons released, for death, disability, personal injury, property damage, property theft, or actions of any kind which may hereafter occur to me including traveling to and from activities/events of this program, THE FOLLOWING ENTITIES OR PERSONS: Hope House, HOG Christian Ministries, The Gathering, and/or their directors, officers, employees, volunteers, representatives, and agents, the activity or event holders, activity or event sponsors, activity or event volunteers; (B)I INDEMNIFY, HOLD HARMLESS AND PROMISE NOT TO SUE the entities or persons mentioned in this paragraph from any and all liabilities or claims made as a result of participation in any program event/activity, whether caused by negligence of release or otherwise. I acknowledge that Hope House, HOG Christian Ministries, and their directors, officers, volunteers, representatives, and agents are NOT responsible for the errors or omissions, acts or failures to act of any party or entity conducting a specific event or activity on behalf of Hope House. Risks may include, but not limited to, those caused by fundraising/production, work, terrain, facilities, temperature, weather, condition of participants, equipment, vehicular traffic, actions of other people.
I understand that Hope House staff is not licensed or insured or professional medical staff; this is a pastoral ministry with assigned staff and volunteers. I hereby consent to receive medical treatment by a licensed provider in the event of injury, accident, and/or illness. I understand that any medical expenses incurred are my personal responsibility regardless if I have insurance; I agree to hold Hope House harmless from any liability for medical expenses incurred as a result of my residency. I understand that as part of this program, I may be photographed. I agree to allow my photo, video, film likeness and approved testimony to be used for any legitimate purpose by the program or designee.
The accident waiver and release of liability shall be construed broadly to provide release and waiver to the maximum extent permissible under applicable law. I CERTIFY THAT I HAVE READ THIS DOCUMENT, AND I FULLY UNDERSTAND ITS CONTENT. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT AND I SIGN IT OF MY OWN FREE WILL.