Sign the waiver online or print one below. All teens and sponsors are required to fill out a waiver form, even if you are not participating in any games or activities. This year, we also have a separate waiver for anyone riding the mechanical bull. Mechanical Bull Waiver Online Waiver Online Waiver Personal Information Name of Teen(s) You may enter multiple names from the same household Name of Parent/Guardian Phone Email Address Address Address Address Address Address State AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Address Is your teen(s) allergic to any medications? No Yes Please specify Please specify for each teen Church attending with: My church is not on this listAmbassador Baptist Church, WadsworthAnchor Baptist Temple, MassillonBerean Baptist Church, MansfieldBible Baptist Church, Grove CityBible Baptist Church, LancasterBible Baptist Church, MercerBible Baptist Church, WillardBible Baptist Church, XeniaCalvary Baptist Church, AshlandCalvary Baptist Church, ShelbyCapitol City Baptist Church, ColumbusCarpenter's House Baptist ChurchCarrollton Baptist TempleCelina Baptist ChurchCentral Baptist Church, ColumbusChurch at Troy, GarrettsvilleCleveland Baptist ChurchColonial Baptist Church, WintersvilleCornerstone Baptist Church, FindlayCornerstone Baptist Temple, DaytonCrossroads ChurchDalton Baptist ChurchEmmanuel Baptist Church, TallmadgeFaith Baptist ElidaFellowship Baptist Church, CantonFellowship Baptist Church, ColumbusFellowship Baptist Church, EmlentonFellowship Baptist Church, MansfieldFirst Baptist Church of SpringboroFirst Baptist Church, AshlandFirst Baptist Church, SpencerFirst Baptist Church, StreetsboroFremont Baptist Temple, FremontGrace Baptist Church, BrunswickGrace Baptist Church, SidneyGrand River Baptist Church, PainesvilleHeartland Baptist Church, MarysvilleHeritage Baptist Church, Canal WinchesterHigh Street Baptist Church, ColumbusHillcrest Baptist Church, ButlerLake Milton Baptist ChurchLakeland Baptist Temple, EastlakeLiberty Baptist Church, BeavercreekLiberty Baptist Church, MassillonLiberty Baptist Church, Van WertLighthouse Baptist Church, HermitageLisbon Baptist ChurchLoudonville Baptist TempleMansfield Baptist TempleMansfield Freewill Baptist ChurchMaranatha Baptist Church, AshlandMaranatha Baptist Church, ShelbyMassillon Baptist Temple, MassillonMount Vernon Baptist Temple, HowardNew Beginnings Freewill Baptist Church, MansfieldNew Life Church, WhitehallNew Testament Baptist Church, BurtonNewark Baptist Temple, HeathNorth Columbus Baptist TempleNorthLife Baptist Church, WoosterNorwalk Baptist ChurchPark Gate Baptist, Ellswood CityPickerington Baptist Temple, PickeringtonPuzzletown Road Bible Church, DuncansvilleSlippery Rock Baptist ChurchSoul's Harbor Baptist Church, MariettaSouthwest Baptist Church, BrunswickStoryside ChurchWalnut Creek Baptist Church, ErieWashington Township Baptist Church, ZanesvilleWayside Chapel, Bucyrus Church Name, City Release of Liability CONSENT and ACKNOWLEDGEMENTParent(s)/Guardian(s): I/We the undersigned Parent(s)/Guardian(s) (also referred to throughout as "I"), hereby authorize and consent to my child's participation and involvement in the activities of the Buckeye Teen Harvest Rally (A ministry of Mansfield Baptist Temple). Activities shall include but not limited to, participation in all events sponsored or organized by or through the Buckeye Teen Harvest Rally such as: games, and sport activities. (the "Activities").CHILD-PARTICIPANTI, the undersigned Participant (also referred to throughout as the "child"), understand that I am to act in a safe and responsible fashion, to follow the instructions and directions of the person in charge of the Buckeye Teen Harvest Rally. I understand and agree to obey request to comply with safety regulations as directed by the person in charge of the Buckeye Teen Harvest Rally.ASSUMPTION OF RISKSI acknowledge that I am aware of the possible RISKS, DANGERS AND HAZARDS associated with participation in the Activities including thepossible risk of severe or fatal injury to others or myself. These risks include but are not limited to the following: risks associated with failing to following instructions of the person in charge of the activities, risks associated with the participation in the activities, risks associated with medical problems arising before, during and following participation in activities, and other not mentioned probable and unforeseen risks.DISCLAIMER and RELEASE OF LIABILITYI, for myself or my child, voluntarily accept and fully assume such risks, dangers and hazards and the possibility of personal injury, death, partial or permanent disability, property damage or loss resulting from my or my child's participation in the activities. I release, indemnify and hold harmless the Buckeye Teen Harvest Rally, its volunteers, members, its location affiliates and representatives from: a) any loss, personal injury, accident, misfortune or damage to the above named or his/her property, with the understanding that reasonable precautions shall be taken to ensure the health and safety of the below named, b) any claims, demands, actions and costs for any loss, injury, damage or expense whatsoever that might arise out of my or my child's participation in the activities, and c) any and all liability for any damage to the personal property of, or personal injury to, any third party resulting from my or my child's participation in the activities.ACKNOWLEDGEMENTI understand that this is a legal agreement that is binding upon my heirs, my executors, administrators, successors, assigns and myself. I acknowledge that I have read and understand the terms of this agreement and acknowledge that by signing this agreement voluntarily, I am agreeing to abide by its terms and I am waiving certain legal rights that my child and I may have. I understand that my digital signature, whether drawn or typed, is legally binding and holds me to this agreement. This consent, authorization, and acknowledgement will be effective for the Buckeye Teen Harvest Rally on Saturday, September 14th, 2024. I have read and agree with the Release of Liability Yes No Parent/Guardian's Signature signature keyboard Clear Please write your name in the box above Submit If you are human, leave this field blank. Printable Waiver Print or download a paper copy of the waiver to fill out and turn in at the rally. 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