Magnify Church

Medical Release Form

By completing this Medical Release Form, you are agreeing to the following statements:

Section 1

I hereby give my permission (if applicant is a minor) for the applicant to participate in the Magnify Church activities and
trips including transportation from/to Magnify Church.
If emergency medical procedures or treatments are necessary during the event, I authorize Magnify Church staff or representatives to arrange for and consent to the procedures or treatment. I recognize
that any medical treatment that is provided while attending a Magnify Church activity/trip will
be paid for by me or my insurance company.
Waiver and release of liability: In consideration of the applicant's participation, I hereby waive and release the
officers, agents, employees and volunteers of Magnify Church from any and all claims that I or
my minor may have for losses, damages, or injuries arising out of or resulting from my minor’s participation in
the program, whether or not caused by the negligence of the officers, agents, employees or volunteers of
Magnify Church. I HAVE READ AND VOLUNTARILY SIGNED THIS WAIVER AND RELEASE OF
LIABILITY AND PERMISSION FORM.
I verify that the applicant is in good health and is capable of participating in strenuous activities, and when
necessary, will tailor activities to those within the bounds of applicant’s physical health. The applicant also
agrees they will cooperate with leaders and other staff, and applicant’s behavior will be honoring to God.

Section 2

Please be advised that you will be asked to give (or deny) permission for Magnify Church to use the applicant's picture, name, voice and/or likeness.

By checking yes in the Section 2 portion of this Medical Release Form you are agreeing to the following:

Authorization to use picture, name, voice and likeness: I hereby, on behalf of myself, my heirs, executors and
administrators, sell, grant, assign and deliver to Magnify Church, its subsidiaries and affiliated
companies, its successors, agents, licensees and assigns (Magnify Church), and those acting
under its permission or upon its authority, the exclusive right to own, copyright, use, reproduce, publish, license,
assign, display, retouch and/or alter at any time and in any media, now known or hereafter developed for any
lawful purpose, photographic and/or audio visual materials including my image and any recording of my voice
associated therewith, and to make any changes and/or additions thereto, or derivative works there from, for
reproduction and/or publication in conjunction with either my own or fictitious names, testimonial copy, or
otherwise. I specifically waive and surrender any claim which I may now have or hereafter have that use of the
work referenced above would constitute an invasion of my privacy. I release Magnify Church of
any compensation or financial claim by me as a result of these recorded images or said project.
I hereby warrant that I am of legal age and have every right to contract in my own name, or that I am the parent,
legal guardian, or authorized agent of the talent whose name appears below.
I state further that I have read this
agreement, prior to its execution, and that I am fully familiar with the content thereof.
This contract constitutes the entire agreement between Magnify Church and me and
supersedes any and all other agreements, statements, representations and understandings, whether made
verbally or in writing, concerning the subject matter of this agreement and may only be modified in writing
signed by Magnify Church.

Date/Time:
1/1/2020 12:00 AM - 12/31/2025 11:59 PM
Add To Your Calendar
Location
All Locations
Contact:
Carol Gates
(616) 866-9597
[email protected]
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