Participants Form – Wonder Voyage Portal

Name

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Wonder Voyage Release Form

If you are 18 years of age or older, you must fill out your own waiver form, please do not combine adult family members on one waiver form.

Parent/Guardian Information

Parent/Guardian Name(Required)

If you are a participant over 18, enter your information below.

First Last

Parent/Guardian Email(Required)

Home Phone(Required)

Cell Phone

Work Phone

Choose Your Voyage(Required)

Voyage ID

Voyage Title

Voyage Location

Voyage Title - Location

All adults must have their own waiver, please do not combine adult family members on one form.

Participants

Name	Role	Gender	Age	Medical restrictions/Dietary allergies	Actions

There are no Participants.

Emergency Contact(Required)

First Last

Emergency Phone(Required)

Relation to Participant(s)(Required)

Organization

Voyage Location

For the above Voyage (hereinafter “EVENT”) I, being 18 years of age or older, for myself and/or on behalf of my minor participant if said minor is not 18 years or older and for my/minor’s heirs, assigns, executors, and administrators do hereby fully release, forever discharge and agree to hold harmless Wonder Voyage Missions, Inc., its directors, employees, contractors, sponsors, or agents (hereinafter “WVM”) thereof from any and all liability to myself and/or my minor participant for any claims of damage to or loss of property, any injury to person, death or any one or more of the foregoing, arising directly or indirectly out of either mine or my minor’s participation for any purpose in the EVENT. THIS RELEASE INCLUDES ANY DAMAGE, LOSS OR INJURY THAT IS CAUSED BY ANY ACT OR OMISSION ON THE PART OF WVM, INCLUDING ANY NEGLIGENT CONDUCT OF WVM but excluding any gross negligence or willful misconduct of WVM. IT IS MY EXPRESS INTENT THAT THE ABOVE RELEASE INCLUDES THE RELEASE BY ME ON BEHALF OF MYSELF AND/OR MY MINOR PARTICIPANT OF WVM FROM THE CONSEQUENCES OF WVM'S OWN NEGLIGENCE. I FURTHER AGREE TO INDEMNIFY, DEFEND, AND HOLD HARMLESS WVM for, from, and against any and all liabilities, damages, claims, lawsuits, costs (including court costs, attorneys fees and costs of investigation), and actions of any kind for any damage to or loss of my property or the property of another, any injury to me or my death, or the injury or death of any other person or any one or more of the foregoing, arising out of either mine or my minor’s participation in the EVENT, INCLUDING ANY DAMAGE, LOSS OR INJURY CAUSED BY ANY ACT OR OMISSION ON THE PART OF WVM INCLUDING ANY NEGLIGENT CONDUCT OF WVM but excluding any gross negligence or willful misconduct of WVM. IT IS MY EXPRESS INTENT THAT THE ABOVE INDEMNITY INCLUDES INDEMNIFICATION BY ME OF WVM FROM THE CONSEQUENCES OF WVM'S OWN NEGLIGENCE.

I hereby acknowledge that I recognize and assume for myself and/or on behalf of my minor participant all of the risks associated with the EVENT. I UNDERSTAND THAT WVM DOES NOT PROVIDE INSURANCE COVERAGE OF ANY KIND, AND THAT NO INSURANCE COVERAGE MAY EXIST THROUGH WVM TO COVER ANY INJURIES OR DAMAGES WHICH MAY ARISE AS A RESULT OF PARTICIPATION IN THE EVENT. I ACKNOWLEDGE THAT IT IS MY SOLE RESPONSIBILITY TO SECURE INSURANCE COVERAGE FOR MYSELF AND/OR MY MINOR IF I SO DESIRE SAID COVERAGE.

The terms of this Release and Indemnity Agreement are to be governed by and construed under the laws of the State of Texas, and VENUE WITH RESPECT TO ANY DISPUTE ARISING BETWEEN WVM AND ANY OTHER PARTY THAT INVOLVES THIS RELEASE AND INDEMNITY AGREEMENT OR MY PARTICIPATION IN THE EVENT SHALL BE EXCLUSIVELY IN DENTON COUNTY, TEXAS.

Each provision of this Release and Indemnity Agreement is severable and if one portion is invalid or illegal, such invalid or illegal portion shall not apply, but the remaining portions shall nevertheless remain in full force and effect.

In making this Release and Indemnity Agreement, I have not relied upon any statement or representation pertaining to this matter made by WVM or any other person or entity which is hereby released. I WARRANT THAT I HAVE CAREFULLY READ THIS DOCUMENT AND KNOW ITS CONTENTS, AND THAT I AM 18 YEARS OF AGE OR OLDER AND HAVE FULL AUTHORITY TO EXECUTE THIS DOCUMENT AND THAT I HAVE EXECUTED THIS DOCUMENT VOLUNTARILY AND AS MY OWN FREE ACT. I EXECUTE THIS DOCUMENT FULLY INTENDING TO BE BOUND BY ITS TERMS.

Furthermore, I, and on the behalf of my minor participant if under the age of 18 years, authorize and permit WVM to furnish any necessary transportation, food, lodging, and possible medical attention for this participant.

(If the participant has not attained the age of 18 years):

I am the parent or legal guardian of this participant, and hereby grant my permission for him/her to participate fully in said EVENT, and hereby give my permission to take said participant to a doctor or hospital and hereby authorize medical treatment, including but not limited to emergency surgery or medical treatment, and I assume the responsibility of all medical bills and expenses, if any. Further, should it be necessary for the participant to return home due to medical reasons, disciplinary action, or otherwise, I hereby assume all transportation costs.

Medical Authorization

In the event that I cannot be reached in an emergency, I give permission to the Pilgrimage leaders to secure and administer treatment for my child including hospitalization, anesthesia, surgery, and necessary transportation. I will not hold these leaders responsible for the consequences of exercising this power so long as they act in good faith with the best interest of my child in mind. I further consent to any treatment by any hospital or physician, which, in their judgment, is in the best interest of my child. I expect to be informed of my child’s condition and of treatment provided as soon as possible.

Legal Consent(Required)

I agree to the terms and conditions.

Consumer Disclosure Regarding Conducting Business Electronically, Signing Documents Electronically, and Receiving Electronic Notices and Disclosures

Please read the information below, carefully, as it concerns your rights. eSignatures are an efficient way to execute an agreement with the same legal force and effect of a handwritten or “wet ink” signature. By signing this document you are agreeing that you have reviewed this Consumer Disclosure and consent and intend to transact business electronically; to use electronic signatures instead of wet ink signatures and paper documents, and to receive notices and disclosures electronically.

You are not required to sign documents electronically or to receive notices and disclosures electronically. If you prefer not to transact business electronically, you may request paper copies from the “sending party” and withdraw your consent at any time, as described below.

Scope of Consent
By utilizing this Service, you agree to receive electronic signature documents with all related and identified documents, notices, and disclosures provided during your relationship with the “sending party.” You may withdraw your consent, at any time, by following the procedures outlined below.

Paper Copies
You are not required to sign documents electronically, or receive notices or disclosures electronically, and may request paper copies of documents or disclosures, if you prefer. You also have the ability to download and print any signed or unsigned documents sent to you through the electronic signature service. We may also email you a copy of all documents you sign using the electronic signature service. If you wish to receive paper copies instead of electronic documents you may close this web browser and request paper copies from the “sending party” by following the procedures outlined below. The “sending party” may apply a charge for additional expenses incurred by printing and mailing paper copies.

Withdrawal of Consent
You may withdraw your consent to receive electronic documents, notices or disclosures at any time. In order to withdraw consent you must notify the “sending party” that you wish to withdraw your consent to transact business electronically and to provide your future documents, notices, and disclosures in paper format. If at any time, after withdrawing your consent you choose to use our electronic signature system your use of this Service will, once again, evidence your consent to receive documents, notices, and disclosures, electronically. You may withdraw your consent to receive electronic notices and disclosures or execute an electronic signature by following the procedures described below.

Withdrawing your consent, requesting a paper copy, or updating your contact information
You always have the ability to download and print any documents sent to you through our electronic signature system. To withdraw your consent to conduct business electronically, sign documents electronically, and receive documents, notices, or disclosures electronically, please contact the “sending party” directly; by telephone, by email (sent to the “sending party” with any of the topics outlined below stated in the subject line of your email) or by postal mail to their mailing address specified to receive such notices.

“Withdrawal of Consent To Transact Business Electronically” To allow the “sending party” to identify and facilitate your withdrawal of consent to transact business electronically, please provide your name, email address, the date on which you are withdrawing your consent, your telephone number and mailing address.

“Requesting A Paper Copy” To allow the “sending party” to identify you to provide a paper copy of the document requiring your signature, the notice, or disclosure, please provide the sending party with your name, email address, mailing address, telephone number, and name of the document of which you are requesting a paper copy .

“Update Your Contact Information” To allow the “sending party” to identify you in order to update your contact information, please provide them with your name, email address, mailing address, and telephone number.

The “sending party” will inform you of any fees related to costs for printing and mailing paper copies or your withdrawal consent to transact business electronically.

Signature(Required)

Manual Entry

No

Yes