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JHIGH GIRLS LOCK-IN 2013
WAIVER AND RELEASE

I hereby give my child/ward, ______________________________________ (“Student”),
permission to participate in the JHIGH GIRLS LOCK-IN on February 9-10, 2013 (“Girls Lock-
In”).
I understand that my Student will engage in a wide-range of activities at the Girls Lock-In
including, but not limited to, basketball, dodge ball, kick ball, gaga ball, scavenger hunts, food
fights, water balloon fights, obstacle courses, survivor challenges (including but not limited to
eating challenges), and various challenges/games. There are risks associated with participation in
these activities and I understand that my Student may suffer serious injury or even death.
Understanding and assuming all risks, I give my Student permission to participate in all of the
activities at the GIRLS LOCK-IN. I fully and solely accept both the risks and consequences of
my Student’s participation and will not seek to recover costs or damages of any kind from
Second Baptist Church.
I agree that my Student will abide by all rules and will respect the staff, leadership, employees,
agents, representatives, chaperones, volunteers, other children/students, and the property of
Second Baptist Church or of third parties. I have advised my Student not to engage in horseplay
and to follow all directions and instructions. I further understand that I am financially
responsible for any damage to public or private property caused in whole or in part by my
Student.
I HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS SECOND BAPTIST
CHURCH, ALL SECOND BAPTIST CHURCH STAFF, EMPLOYEES, LEADERSHIP,
AGENTS, CHAPERONES, REPRESENTATIVES, MEMBERS, AND VOLUNTEERS
(ALL COLLECTIVELY REFERRED TO AS “SECOND BAPTIST CHURCH”) FROM
ANY AND ALL CLAIMS AND LIABILITIES OF WHATSOEVER NATURE, BOTH
INDIVIDUALLY AND COLLECTIVELY, THAT MAY ARISE FROM MY ABOVE-
NAMED STUDENT’S PARTICIPATION IN THE GIRLS LOCK-IN, WHETHER OR
NOT THE CLAIMS OR LIABILITIES OCCUR ON THE PROPERTY OF SECOND
BAPTIST CHURCH, AND WHETHER OR NOT SUCH CLAIMS OR LIABILITIES
ARISE OUT OF THE NEGLIGENCE OR OTHER CONDUCT OF SECOND BAPTIST
CHURCH.
I further agree that Second Baptist Church representatives have the authority to authorize or
provide such emergency medical, dental, surgical care or treatment and are authorized to make
all medical, dental or surgical care decisions as may be necessary in their judgment for my
Student during his/her participation in any activities affiliated with Second Baptist Church. I
understand that I will be financially responsible for any costs incurred in the emergency
treatment and/or transportation of my Student.
I hereby grant permission for the staff, leadership, employees, agents, representatives,
chaperones, and/or volunteers of Second Baptist Church to administer over-the-counter
medications to my Student including but not limited to: Tylenol, Advil, Tums, Benadryl, Anti-
Itch Cream, Triple Antibiotic Cream, Benadryl Cream, Cough Drops, Throat Spray or Lozenges.
I agree to notify Second Baptist Church, in writing, of any of my Student’s medical allergies.
JHIGH GIRLS LOCK-IN 2013
WAIVER AND RELEASE

I, THE PARENT/GUARDIAN OF THE ABOVE-NAMED STUDENT, DO HEREBY
GIVE OVER AND RELEASE UNTO THE STAFF, LEADERSHIP, EMPLOYEES,
AGENTS, REPRESENTATIVES, CHAPERONES, AND/OR VOLUNTEERS OF
SECOND BAPTIST CHURCH ALL AUTHORITY AND RESPONSIBILITY TO
AUTHORIZE ANY AND ALL MEDICAL TREATMENT NECESSARY FOR THE
PROTECTION OF THE HEALTH AND WELL-BEING OF MY AFOREMENTIONED
STUDENT. THIS AUTHORIZTION SHALL AUTHORIZE ANY AND ALL MEDICAL
TREATMENT BY LICENSED MEDICAL PERSONNEL, PURSUANT TO THIS MY
EXPRESS AUTHORIZATION, WHETHER WRITTEN OR ORAL, OF THE STAFF,
LEADERSHIP, EMPLOYEES, AGENTS, REPRESENTATIVES, CHAPERONES,
AND/OR VOLUNTEERS OF SECOND BAPTIST CHURCH.
THIS AUTHORIZATION SHALL BE EFFECTIVE UNTIL IT IS EXPRESSLY
REVOKED.

I further understand that my Student will be using the facilities of Second Baptist Church and
facilities owned and operated by third parties. I further understand that my Student may be
transported in vehicles or equipment owned, leased, or rented by Second Baptist Church, and
that third parties may operate such equipment. I understand that I am, by signing this document,
releasing Second Baptist Church from all claims and liability whatsoever.

Second Baptist Church has my permission to use, without any compensation, any photographs,
videos, recordings or other media for the purposes of brochures, videos, advertising, website, or
other promotional items, and waive any right of ownership to such media or other claim I may
have to receive any royalty or other compensation for such use. I further understand that these
photos/videos will be used for Second Baptist Church promotional purposes only.

I have had the opportunity to speak with legal counsel regarding this Waiver and Release and
understand that I am giving up any and all claims against Second Baptist Church arising from my
Student’s participation in the GIRLS LOCK-IN.
Parent/Guardian’s Signature:__________________________________ Date:

Source: http://second.org/ConvergeFiles/4df43d7b/GIRLS%20LOCK-IN%202013%20Release%20Form.pdf