As the parent/guardian, I hereby grant, voluntarily and with full understanding, to North Mount Zion Church (hereafter referred to as "the Church"), a license to the following:
1. Use and storage of my name and image, by means of digital or film photography, video photography, audio recording or other documentation, with respect to the activity, namely Mountaineers Kids Club, of the Church.
2. Use of any stored data including my name and image in printed publications of the Church.
3. Use of any stored data including my name and image in electronic publications of the Church.
4. Use of any stored data including my name and image in any website created by or for the Church for its sole benefit.
5. If I am electronically signing this agreement on behalf of a minor child, I hereby warrant that I am the legal parent or guardian of the child and that I have the legal authority to sign this agreement on behalf of the child.
6. If a dispute over this agreement or any claim for damages arises, I agree to resolve the matter through a mutually acceptable alternative dispute resolution process. If I cannot agree with the Church upon such a process, the dispute will be submitted to a three-member arbitration panel for resolution in accordance with the rules of the American Arbitration Association for final resolution.

I am a parent/guardian of the aforementioned minor(s). I grant my permission for him/her to participate in Mountaineers Kids Club, an activity sponsored by North Mount Zion Church (hereafter "the Church"). In consideration of my child’s participation in the activity, I agree to forever indemnify and hold harmless the Church, its employees, agents, and volunteers from any liability or costs they may suffer as a result of claims, demands, costs or judgments arising out of my child’s participation.
I hereby give my consent in the event reasonable attempts to contact me at phone numbers I provided have been unsuccessful for the administration of any treatment deemed necessary by a physician or dentist and the admission or transfer of my child to any hospital reasonably accessible. This authorization does not cover major surgery unless the medical opinion of another licensed physician or dentist concurring in the necessity for such surgery is obtained in writing prior to the performance of surgery. I agree that the Church will not be responsible for medical expenses incurred.
This release covers transportation provided by the Church and its representatives who are properly licensed to drive in the state of Ohio, meetings on the Church campus site or any other site during programs and activities, refreshments, purchased or homemade that will be served at above program.
This Liability Release Form will remain in effect as long as the named minor is a participant in the program, or the minor reaches reaches 18 years of age.