Yearly Liability Form

indicates a required answer

1. *

Student's Name
2. *

Gender
3. *

Student's Birthdate
4. *

Street Address
5. *

City
6. *

State
7. *

Zip Code
8. *

Email Address
9. *

Parent or Guardian's Name
10. *

Primary Emergency Contact's Name
11. *

Primary Emergency Contact's Phone Number
12. *

Emergency Contact Relationship to Student
13. *

Secondary Emergency Contact Name
14. *

Secondary Emergency Contact's Phone Number
15. *

Secondary Emergency Contact's Relationship to Student
16. *

Statement of Service: I, the undersigned am a Participant, Volunteer, or Staff of Tower Hill Church.

 (1 required)
Yes
17. *

Agree To Follow Directions: I, the undersigned Participant, agree to observe and obey all posted rules and warnings, and further agree to follow any oral instructions or directions given by Tower Hill Church, or the employees, representatives, or agents of Tower Hill Church.

 (1 required)
Yes
18. *

Assumption of Risk and Release:I recognize that there are certain inherent risks associated with the above-described ministries and services that I participate in and I assume full responsibility for personal injury to myself and (if applicable) my family members, and further release and discharge Tower Hill Church for injury, loss, or damage arising out of my presence during regularly scheduled services, meetings or ministries upon the facilities of Tower Hill Church or at any offsite Tower Hill Church sponsored activity, whether caused by the fault of myself, my family, Tower Hill Church or other third parties. I acknowledge and accept that this assumption of risk applies to all areas in which I am participating or serving within Tower Hill Church or through a Tower Hill Church activity conducted outside of Tower Hill Church.

 (1 required)
Yes
19. *

I, Parent or Guardian of the above named student, residing at the address listed above, give permission for my child to volunteer and or participate in the following activities, and agree on behalf of the above minor to all of the terms and conditions of this agreement. By signing this Release of Liability, I represent that I have legal authority over and custody of minor named above.
By typing my name below, I understand and agree that this form of electronic signature has the same legal force and effect as a manual signature.
20. *

Medical Authorization.In the event of an illness, injury, or medical emergency involving myself or my minor child, I authorize Tower Hill Church and its representatives to obtain appropriate emergency medical care and treatment as reasonably necessary. I understand that I am responsible for any resulting medical expenses. I further release and hold harmless Tower Hill Church, its staff, volunteers, and representatives from liability arising from emergency assistance provided in good faith, except in cases of gross negligence or intentional misconduct.

 (1 required)
Yes
21. *

Behavioral Expectations: I understand that participants are expected to behave in a respectful, safe, and cooperative manner. Tower Hill Church reserves the right to remove participants whose behavior is disruptive, unsafe, or inappropriate. I acknowledge that Tower Hill Church may not be equipped to safely support all behavioral, developmental, medical, or physical needs and may require additional parental supervision or alternative arrangements when necessary.

 (1 required)
Yes
22. *

Food Allergy and Exposure Acknowlegment: I understand that while Tower Hill Church designates its classrooms as nut-free environments and makes reasonable efforts to accommodate known allergies, an allergen-free environment cannot be guaranteed. Due to Food Ministry operations and food brought by participants, exposure to nuts and other allergens, including accidental cross-contamination, may occur. I acknowledge and accept these risks and release and hold harmless Tower Hill Church, its staff, volunteers, and representatives from liability related to allergic reactions, except in cases of gross negligence or intentional misconduct.

 (1 required)
Yes
23. *

Food Allergies
24. *

Medication Allergies
25. *

Environmental Allergies
26. *

(This policy does not apply to Agape Co-op. We have a no camera/recording policy)

Livestream Disclosure: I understand that Tower Hill Church may livestream or record worship services, classes, meetings, and special events. While cameras are generally focused on the platform, stage, or primary activity area, incidental audio or video of attendees may be captured. By participating in church activities, I acknowledge and accept the possibility of appearing in livestream or recorded footage.

 (1 required)
Yes
27. *

Media Release

 (1 required)
Yes, I grant Tower Hill Church the right to photograph, record, and use the image, likeness, voice, and/or name of myself or my minor child in any media format, including print, digital, and online platforms. I understandthat these materials may be used for promotional, informational, or ministry-related purposes. I further authorize Tower Hill Church to edit, reproduce, distribute, and copyright such materials without compensation, and waive any rights to inspect or approve the final product. This release applies to all current and future uses and remains in effect unless revoked in writing by notifying the church office. No, I do not give permission for Tower Hill Church to use images, videos, or recordings of myself or my minorchild in any media format. If you opt out of the media release, Tower Hill Church will make reasonable efforts toexclude you or your child from photos and recordings. However, incidental inclusion may still occur.
28. *

Applicable Law: Any legal or equitable claim that may arise from participation in the above shall be resolved under New Hampshire law.
No Duress: I agree and acknowledge that I am under no pressure or duress to sign this agreement and that I have been given a reasonable opportunity to review it before signing. I further agree and acknowledge that I am free to have my own legal counsel review this agreement if I so desire. I further agree and acknowledge that Tower Hill Church has offered to refund any fees I have paid to use its facilities if I choose not to sign this agreement.
Arm's Length Agreement: This agreement and each of its terms are the product of an arm's length negotiation between the Parties. In the event any ambiguity is found to exist in the interpretation of this agreement or any of its provisions, the Parties, and each of them, explicitly reject the application of any legal or equitable rule of interpretation which would lead to a construction either "for" or "against" a particular party based upon their status as the drafter of a specific term, language, or provision giving rise to such ambiguity.
Enforceability: The invalidity or unenforceability of any provision of this agreement, whether standing alone or as applied to a particular occurrence or circumstance, shall not affect the validity or enforceability of any other
provision of this agreement or of any other applications of such provision, as the case may be. Such invalid or unenforceable provision shall be deemed not to be a part of this agreement.
Dispute Resolution: The parties will attempt to resolve any dispute arising out of or relating to this agreement through friendly negotiations among the parties. If the matter is not resolved by negotiation, the parties will resolve the dispute using the below Alternative Dispute Resolution (ADR) procedure: Rev 9.23.25
Any controversies or disputes arising out of or relating to this agreement will be submitted to mediation in accordance with any statutory rules of mediation. If mediation is not successful in resolving the entire dispute or is unavailable, any outstanding issues will be submitted to final and binding arbitration under the rules of the American Arbitration Association. The arbitrator's award will be final, and judgment may be entered upon it by any court having proper jurisdiction.

Digital Signature: By typing my name below, Participant acknowledges that this serves as my legal signature and agreement to the terms above and that my digital signature is legally binding under the Electronic Signatures in Global and National Commerce Act (ESIGN) and other applicable laws.

I HAVE READ THIS DOCUMENT AND UNDERSTAND IT. I FURTHER UNDERSTAND THAT BY SIGNING THIS RELEASE, I VOLUNTARILY SURRENDER CERTAIN LEGAL RIGHTS.
By typing my name below, I understand and agree that this form of electronic signature has the same legal force and effect as a manual signature.
29. *

Today's Date
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