Waiver & Media Release (2026/2027) - Youth Ministry

An adult must fill out this form. Included is a Release, Waiver, and Indemnity Agreement along with a Photo & Video Release for the school year of 2026/2027.

Student Information

In reference to "NAME OF MINOR" below.

Emergency Contact

If different from your contact information already entered at the top of this form.

Photo & Video

I, the legal parent/guardian of (NAME OF MINOR), hereby authorize and consent to the use of images or videos of my child/children listed above, with or without their name(s), by DEWITT E-FREE of DEWITT, IOWA for purposes including but not limited to: promotional materials, printed publications, internet posts including social media, television, and other media sources.

I do this with full knowledge and consent and waive all claims for compensation for use or for damages. I release DEWITT E-FREE, its officers, trustees, employees, and agents from liability for any claims by me or any third party in connection with the use of the image of my child/children listed above.

I understand that the church website and official social media accounts(s) are available to the public and accessible to individuals anywhere in the world.

WAIVER AND RELEASE OF LIABILITY **READ BEFORE SIGNING**

In consideration of being allowed to participate in any way in related events and activities with DeWitt Evangelical Free Church, the undersigned acknowledges, appreciates, and agrees that:

I understand that there exists a risk of injury from the activities my child might participate in with DeWitt Evangelical Free Church.

I understand that while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist.

I understand that my child is expected to comply with all stated and customary rules for participation. If, however, they observe any unusual significant hazard during an event, they will remove themselves from participation and bring the issue to the attention of the nearest event leader immediately.

For and in consideration of permitting (NAME OF MINOR) to observe, or use any facility or equipment of DEWITT EVANGELICAL FREE CHURCH (DEWITT E-FREE), or engage in and/or receive instruction in any activity or activity incidental thereto SOME OF WHICH MAY INVOLVE DANGERS AND RISK OF BODILY INJURY at: DeWitt E-Free in the city of DeWitt, County of Clinton, and State of Iowa, during the year of 2023, the undersigned parent and/or guardian of (NAME OF MINOR): hereby voluntarily and absolutely releases, discharges, waives, and relinquishes any and all loss or damages or actions or causes of action for personal injury, property damage, or wrongful death occurring to (NAME OF MINOR) as a result of (NAME OF MINOR)'s observing or using facilities or equipment of DEWITT E-FREE, or engaging in or receiving instructions in any activities SOME OF WHICH MAY INVOLVE DANGERS AND RISK OF BODILY INJURY or in activities incidental thereto wherever or however the same may occur, and for the year of 2023.

The undersigned parent or guardian of (NAME OF MINOR) for him/herself, his/her heirs, executors, administrators, or assigns agrees that in the event any claim for personal injury, property damage, or wrongful death shall be prosecuted against DEWITT E-FREE or its officers, agents, servants, or employees, the undersigned parent or guardian will indemnify and hold harmless DEWITT E-FREE and its officers, agents, servants, or employees from any and all claims or causes of action by (NAME OF MINOR) or by any other person or entity, by whomever or wherever made or presented, and under no circumstances will the undersigned parent or guardian of (NAME OF MINOR) present any claim against DEWITT E-FREE and said persons for personal injuries, property damage, wrongful death, or otherwise, caused by any act of negligence by DEWITT E-FREE and said persons.

The undersigned parent or guardian represents that he/she has read this digital waiver/release form, has requested and has been provided with, or has requested and declined advisement on the potential dangers/risks of engaging in the observation, activities, or instruction offered, assumes all risks associated with such dangers and risks, and is fully aware of and understands the terms and the legal consequences of the signing of this Release. The undersigned parent or legal guardian intends his or her signature to be a complete and unconditional release of all liability to the greatest extent allowed by law and if any portion of the Release is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.

By applying my electronic signature to this agreement, I agree that my electronic signature is the legally binding equivalent of my handwritten signature on paper. I will not, at any future time, claim that my electronic signature is not legally binding or enforceable. By electronically signing and submitting this agreement, I (1) acknowledge that I have read and fully understand the terms of the agreement; (2) voluntarily agree to be bound by this agreement; and (3) certify that I am 18 years of age or older. My signature applies to all parts of this contract.

A parent or legal guardian must sign this agreement on behalf of any minor participant under the age of 18. By electronically signing this agreement, I represent that I have the authority to sign and enter into this agreement on behalf of the minor(s) listed above.