SOURCE YOUTH ANNUAL RELEASE FORM 25/26

A parent or legal guardian must fill out this form.
Please check each section to confirm compliance.

Your name *

Email address *

Child's information

Child's Name *

Child's Age *

Allergies or Medical Issues *

Emergency Contact

Name *

Relationship to Child *

Phone Number *

RELEASE OF LIABILITY - READ BEFORE SIGNING

In consideration of being allowed to participate in any way in SOURCE STUDENT MINISTRIES functions for the 2025- 2026 calendar year (Brotherhood, Sisterhood, Teen Bible Quiz, Fine Arts, Youth Convention, and Other) the undersigned acknowledges, appreciates, and agrees that:

1) Injury Risk *

The risk of injury from the activities involved in this program is significant, including the potential for permanent paralysis and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and

2) Assuming Risk *

I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation; and,

3) Comply with Conditions *

I willingly agree to comply with the stated and customary terms and
conditions for participation. If, however, I observe any unusual significant
hazard during my presence or participation, I will remove myself from
participation and bring such to the attention of the nearest official
immediately; and

4) Transportation *

I hereby authorize FOUNTAIN OF LIFE/SOURCE STUDENT MINISTRIES permission to transport my child in a fully insured FOLC vehicle with an approved, background checked and insured adult volunteer.

5) Negligence *

I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS FOUNTAIN OF LIFE AND SOURCE YOUTH MINISTRIES, their directors, officers, officials, agents, volunteers and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event (“RELEASEES”),
WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law.

6) Photo Release *

I hereby grant FOUNTAIN OF LIFE / SOURCE STUDENT MINISTRIES permission to use my likeness and my child's likeness in a photograph, video, or other digital media (“photo”) in any and all
of its publications, including web-based publications, without payment or other consideration.

I understand and agree that all photos will become the property of
FOUNTAIN OF LIFE / SOURCE STUDENT MINISTRIES and will not be returned.

I hereby irrevocably authorize FOUNTAIN OF LIFE / SOURCE STUDENT MINISTRIES to edit, alter, copy, exhibit, publish, or distribute these photos for any lawful purpose. In addition, I waive any right to inspect or approve the finished product wherein
my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photo.

I hereby hold harmless, release, and forever discharge FOUNTAIN OF LIFE / SOURCE STUDENT MINISTRIES from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.

7) Confirm Reading of Release *

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

8) Agreement | Guardian Must Sign *

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 pages of this contract. I understand that if I wish to sign a hard copy of this agreement instead of an electronic version, I must contact the party that requires my signature on this agreement directly.

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.

Signature: PRINT NAME BELOW to sign release: *