Release and Waiver of Liability – I AM Woodland Acres Mural Project (Minor)
This Release and Waiver of Liability (the “Release”) is executed on this ______ day of
_________________, 2019 by __________________________ (“Parent/Guardian”) in favor of
George Davis Ministries, Inc., a Florida non-profit corporation, Impact Church of Jacksonville,
Inc., a Florida non-profit corporation, the City of Jacksonville, The Arts Corner, and Revitalize
Arlington, Inc., a Florida non-profit corporation, their respective trustees, directors, officers,
employees, and agents (collectively, “Facilitators”).
The child _______________________ (“Participant”) desires to be involved in the I AM
Woodland Acres Mural Project (“Event”) and engage in the activities related to that event
(“Activities”). The Parent/Guardian understands that the Activities may include both indoor
and outdoor summer activities.
The Parent/Guardian freely, voluntarily, and without duress executes this Release and agrees to
the following terms:
RELEASE AND WAIVER. Parent/Guardian does hereby release and forever discharge and
hold harmless the Facilitators from any and all liability, claims, and demands of whatever kind
or nature, either in law or in equity, which arise now or in the future from Participant’s
participation in the Event and/or its Activities.
Parent/Guardian understands that this Release discharges Facilitators from any liability
or claim that the Parent/Guardian or Participant may have against Facilitators with respect to
any bodily injury, personal injury, illness, death, or property damage that may result from
Participant’s Activities, whether caused by the negligence of Facilitators or its trustees,
directors, officers employees, or agents or otherwise. Parent/Guardian also understands that
Facilitators do not assume any responsibility for or obligation to provide financial assistance or
other assistance, including but not limited to medical, health, or disability insurance in the
event of injury or illness.
MEDICAL TREATMENT. Parent/Guardian hereby authorizes Facilitator to obtain and
consents to necessary medical care of the Participant for injury, illness, and/or distress arising
during the Event. Parent/Guardian releases and forever discharges Facilitators from any claim
whatsoever which arises or may hereafter arise from any first aid, treatment, or service
rendered in connection with the Participant’s Activities or with the decision by any
representative or agent of Facilitators to exercise the power to consent to medical treatment of
ASSUMPTION OF THE RISK. The Parent/Guardian understands that the Activities include
tasks that may be physically strenuous.
Parent/Guardian hereby expressly and specifically assumes the Participant’s risk of
injury or harm in the Activities and releases Facilitators from all liability for injury, illness, death,
or property damage resulting from the Activities.
INSURANCE. The Parent/Guardian understands that, except as otherwise agreed to by
the Facilitators in writing, Facilitators do not carry or maintain health, medical, or disability
insurance coverage for any Participant. Parent/Guardian is expected and encouraged to obtain
his or her own medical or health insurance coverage for the Participant.
RECORDING RELEASE. Parent/Guardian does hereby grant and convey to Facilitators all
right, title, and interest in any and all photographic images and video or audio recordings made
by Facilitators during the Participant’s Activities, including, but not limited to, any royalties,
proceeds, or other benefits derived from such images and/or recordings.
APPLICABLE LAWS. Parent/Guardian expressly agrees that this Release will be governed
by and interpreted in accordance with the laws of the State of Florida, and is intended to be as
broad and inclusive as permitted by those laws. Parent/Guardian agrees that in the event that
any clause or provision of this Release shall be held to be invalid by any court of competent
jurisdiction, the invalidity of such clause or provision shall not otherwise affect the remaining
provisions of this Release which shall continue to be enforceable.
In witness whereof, Parent/Guardian has executed this Release as of the day and year first
Signature of Parent/Guardian: ______________________________________ Date: _________
Name of Participant: __________________________________ Date of Birth: ____________
In case of emergency:
________________________________ ________________________ ____________
Emergency Contact Name Emergency Contact Phone No. Relationship
PDF copy of photo release and waiver for download