GENERAL RELEASE AND WAIVER OF LIABILITY FORM
1. I confirm that all information listed above is accurate. I acknowledge that I am voluntarily participating in SACRED SERVICE SATURDAY on June 16, 2018 which is coordinated by the CommonUnity Outreach Ministry of the Agape International Spiritual Center of Truth, Inc. (Agape), 5700 Buckingham Pkwy, Culver City, California. I understand that my participation is strictly voluntary, and not required nor mandated by Agape, and by agreeing to participate, no other purpose is intended or implied.
ASSUMPTION OF RISK
1. I understand that my participation in SACRED SERVICE SATURDAY at Agape also involves OTHER COMMUNITY ORGANIZATIONS AND PROJECTS and these other organizations are not affiliated with Agape. I am aware that some activities may include some risk to my personal safety and that Agape cannot and does not guarantee the safe physical environment or condition of any of the locations selected by me as sites for giving my service. I acknowledge and agree that I will, upon entering the areas where my service will be performed, immediately inspect for dangerous conditions, and continuously thereafter, inspect the area; and I further agree that if at any time I determine that there is anything in the physical location that is unsafe, I will advise those in charge and leave the area immediately. I agree to exercise caution with regard to my own safety.
I am participating in these activities with the full knowledge of the risks involved and, I hereby, agree to accept any and all risks that may result from these activities.
RELEASE AND WAIVER OF RIGHTS
2. In consideration of my participation I do hereby release Agape and its affiliates, employees, agents, contractors and volunteers (collectively, the “Released Parties”) from liability and agree that I and my assignees, heirs, distributees, guardians and legal representatives will not make a claim against, sue or attach the property of the Released Parties for injury or damage resulting from acts or omissions, howsoever caused, by the Released Parties with respect to my participation in Sacred Service Saturday, except for injuries or damage arising from grossly negligent or intentional acts or omissions by the Released Parties.
Without limiting the generality of the foregoing, I expressly release the Released Parties from any and all claims I may have, and from any liability, responsibility, duty and obligation from lost property, personal injuries to me from accidents caused by the negligence of others, and from injuries resulting from dangerous conditions on the premises and property of third parties with respect to my participation in Sacred Service Saturday.
3. I agree that any dispute arising out of my participation in this Sacred Service event shall be solely resolved as follows:
A. If I have any claim that is not foreclosed by paragraph 2 above, I will first attempt to resolve it by negotiation between myself and an authorized representative of Agape. I will submit such a claim notice in writing to the Chief Administrative Officer of Agape, Thelma Chichester, or her successor, within 10 days of becoming aware of my claim.
B. If the dispute has not been resolved through negotiation within 120 days after the delivery of my initial claim notice, I agree that I will then engage in mediation between myself and Agape using a mediator to be determined by mutual agreement.
C. Any dispute which has not been resolved by mediation within 120 days of the appointment of a mediator shall be finally resolved by arbitration before a single arbitrator to be determined by mutual agreement. The costs of mediation and arbitration shall be shared equally by the parties.
I HAVE READ THIS GENERAL RELEASE AND WAIVER, and I understand the terms used in it and their legal significance. I understand that I will be performing service on the property or premises of third parties. I understand that I am giving up the right to sue Agape, and I freely and voluntarily do so. I have executed this release voluntarily in exchange for the privilege of participating in this Sacred Service event described above.
AUTHORIZATION FOR EMERGENCY MEDICAL ASSISTANCE FOR UNACCOMPANIED MINORS
I hereby give permission for my child whose name is listed above and who is under the age of 18, to fully participate in SACRED SERVICE SATURDAY on June 16, 2018 which is coordinated by the CommonUnity Outreach Ministry of the Agape International Spiritual Center of Truth, Inc. located at 5700 Buckingham Pkwy, Culver City, California. I have signed a General Release and Waiver Form for my child’s participation in this event.
I will not be accompanying my child during this event. In case of an Emergency, I request that an authorized representative of Agape contact me before rendering any sort of medical care. I understand that all efforts will be made to reach me.
My contact numbers in case of emergency are listed above.
I agree that in the event of a Medical Emergency, if I am unable to be contacted, or the medical emergency is determined to be a life threatening situation, the staff or volunteers of Agape in charge of the event and/or whomever is responsible for Sacred Service Saturday shall have my permission to provide and/or authorize medical personnel to render emergency medical services to my child.
PLEASE CHECK THE BOX BELOW IF YOU AGREE TO THE TERMS AND CONDITIONS LISTED ABOVE.