I hereby consent and grant permission to representatives of Crossroads Leadership College to obtain emergency treatment on behalf of the participant indicated below should the student become ill or accidentally injured and need emergency medical treatment. The undersigned further consent to and hereby authorizes the appropriate medical authorities (i.e. hospital, physician, etc.) to administer such emergency medical treatment deemed advisable or necessary at the time of such emergency medical treatment and any subsequent treatment related to such emergency.
The undersigned hereby indemnifies and does not hold Crossroads Leadership College, Crossroads Church, its offices, directors, employees, and any and all representatives, responsible for damage, or injury arising from this treatment, including without limitation to any personal injury or death.
The undersigned further agrees to be responsible to the supplier of the medical emergency treatment for the payment of any and all medical costs and fees associated with the care and rendering of emergency medical treatment.
In the event of an emergency where medical treatment is required, I Gove permission to the church staff or sponsor to obtain the services of a licensed physician. Please attempt to notify emergency contact immediately concerning any such emergency.
For good and valuable consideration, receipt of which is hereby acknowledged, I hereby
irrevocably grant to you, your affiliates, subsidiaries, successors, assigns and licensees,
throughout the universe, in perpetuity, the exclusive right to photograph me and reproduce
my picture, likeness, poses, appearances, or physical attributes and record and reproduce
my voice and use my name in and in connection with the production, exhibition,
exploitation, advertising, publicizing, and promotion of CROSSROADS CHURCH and its
counterparts. Thereafter referred to as “the Program, (and to interpolate any and all other
audio, visual, musical and other effects therein), in any and all media, whether now known
or hereafter devised, and/or in connection with any byproducts (including without limitation,
novelizations, and soundtrack recordings) and merchandising related to the Program. I
agree that you shall have no obligation to include my likeness in the Program or to produce
the Program, and I hereby release you from any liability for any damages I may suffer from
your failure to produce or distribute the Program.
I hereby agree that I will not assert or maintain against your affiliates, subsidiaries, successors,
assigns or licensees any claim, action, suit or demand of any kind or nature whatsoever,
including without limitation, those grounded upon invasion of privacy or other civil rights,
defamation, libel or slander or for any other reason in connection with the exercise of the
consent of rights I have granted to you, and that in no event shall I have any right to
terminate or rescind this grant and consent or enjoin the production, distribution, advertising,
exhibition or other exploitation of the Program.
I hereby acknowledge that in reliance upon this consent and grant of rights you will incur