Activity/Image Participation Agreement
Name of sponsoring organization: Roseburg Alliance Church Address: 2165 Garden Valley Rd.
Name of sponsor’s coordinator Anna Heacock
Telephone: 541-673-5412
Description of activity: VBS 2025
Date(s) and location of activity: Roseburg Alliance Church
June 23rd - June 27th
Image agreement
I hereby grant, voluntarily and with full understanding, a license to the following:
Use and storage of my child’s name and image, use of any stored data by means of digital or film photography, video photography, audio recording or other documentation, printed publications, electronic publications, and any Web site created by or for Roseburg Alliance for its sole benefit, with respect to the activity, namely VBS of Roseburg Alliance
Participation Agreement
I acknowledge that participation in the activity described above involves risk to the Participant (and to 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) acknowledges and accepts the risks 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.
