PHOTOGRAPH/VIDEO/AUDIO/MEDIA CONSENT & RELEASE FORM I hereby consent to and authorize Congregation of Christ the King
Roman Catholic Church of the Diocese of Baton Rouge (a/k/a Christ the King Parish & Student
Center, “Christ the King”), and all entities, representatives, employees and agents operating in
connection with it or under its authority (its “Affiliates”), without any compensation due to me
therefor, to record, use, edit, reproduce and/or publish photographs, audio, video and/or
other electronic images (“Materials”) that may portray and/or relate to me, my image, likeness
and/or voice.
I understand that any and all such Materials may be used in various print and electronic media,
including but not limited to Christ the King’s website and its publications or for other
endeavors related to Christ the King’s interests. I acknowledge and agree that Christ the King
may use and/or publish Materials relating to me and/or use my name, photograph, voice,
video images and other media relating to me in any manner that it deems appropriate in its
sole discretion in order to promote and/or publicize its programs or for any other lawful
purpose. Christ the King is under no obligation to identify or otherwise credit me for the use
of my name, voice, image, likeness and other media relating to me.
This authorization shall not expire and will remain effective unless and until rescinded in a
writing to that effect signed by me and which is notarized and delivered to an officer of Christ
the King at 11 Fraternity Lane, Baton Rouge, LA 70803.
I hereby release and agree to indemnify, hold harmless and defend Christ the King and each
of its Affiliates from all liabilities, damages, losses, claims, demands, causes of action, costs and
expenses (including without limitation reasonable attorneys’ fees and court costs) of any nature
whatsoever which I, my heirs or any other person acting on my behalf or on behalf of my
estate have or may have relating to, arising from or connected in any way to the Materials or
by reason of any action to which this authorization applies. I certify that I am at least 18 years
of age as of the date of my signing electronically below:
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Dr. Miss Mr. Mrs. Ms. Mx. Prof. Rev.
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RELEASE OF LIABILITY, WAIVER OF CLAIMS, ASSUMPTION OF RISK, INDEMNIFICATION AND ARBITRATION AGREEMENT The Congregation of Christ the King Roman Catholic Church of the Diocese of Baton Rouge, a Louisiana non-profit religious corporation (the “Church”), is facilitating the following events, trips and/or activities:
Type of Event: Pilgrimage to France
Location of Event: France Individual(s) in Charge: Rachel Haydel Date and Time of Departure: Monday, July 13 time TBD by pilgrim Date and Time of Return: Sunday, July 24 time TBD by pilgrim Location of Drop off and pick up: Arrival and departure up to pilgrim – arrive July 14 in Paris, France, and depart from France on Friday, July 24 Mode of Transportation to and from Event: TBD by pilgrim; flights arriving to France and returning from France are completely up to the pilgrim The events, trips and/or activities described above (including, without limitation, all transportation to and from such events, trips and/or activities) are collectively referred to herein as the “Event. ” In consideration for participating in the Event, the undersigned participant (“Participant ”) agrees to the terms and conditions of this Release of Liability, Waiver of Claims, Assumption of Risk, Indemnification and Arbitration Agreement (“Agreement ”) to the fullest extent permitted by law, as follows:
1. Waiver and release of claims. Participant voluntarily, fully and forever waives, releases and covenants not to sue the Church, The Roman Catholic Church of the Diocese of Baton Rouge, a Louisiana non-profit religious corporation (the “Diocese ”), and any of the Church’s or the Diocese’s respective church parishes, schools and other locations, and all of their respective members, directors, officers, clergy, parishioners, officials, owners, managers, directors, agents, representatives, employees, volunteers, invitees and/or other participants, and if applicable, owners and lessors of premises used to conduct the Event (“Releasees ”), from and against any and all claims, causes of action, losses, damages, injuries (including but not limited to bodily injury, pain, mental anguish and/or death), fines, penalties, costs, expenses, fees, payment or any other claims, both present and future, that may be made by Participant against any Releasee, arising out or in any way related to (a) the Event or Participant’s transportation to or from, or participation in, any portion of the Event, or (b) the condition of the premises, whether public or private, on which the Event are conducted (it being agreed and acknowledged that neither the Church nor the Diocese shall be responsible or liable in any way for the condition of such property, for the upkeep or maintenance of such property, or for any defects that could cause bodily harm). Participant understands this waiver and release is intended to be as broad and as inclusive as permitted by the laws of the State of Louisiana and agrees that if any portion hereof is held invalid, the remainder of the waiver and release will continue in full legal force and effect. Participant waives any right to recover any punitive or exemplary damages.
2. Assumption of Risk; Indemnification. The risks of injury and illness (including communicable diseases such as MRSA, influenza, and COVID-19) resulting from the Event are or may be significant, including the potential for permanent paralysis and death. Participant understands that the risks of participating in the Event may be both known and unknown. Participant knowingly and freely assumes all risks, both known and unknown, even if arising from the negligence of Releasees or others, and assumes full responsibility for Participant’s participation in the Event. Participant agrees to indemnify, defend, and hold harmless Releasees for any and all claims, loss, injury, illness (including communicable diseases such as MRSA, influenza, and COVID-19), death, attorney’s fees, and/or expense, wherever, whenever, or however the same may occur, that Participant may suffer arising out of or in any way related to Participant’s participation in any portion of the Event.
3. Consent to Authorize Medical Treatment. Participant authorizes the Church and/or the Diocese to obtain emergency medical treatment for Participant if Participant is injured during participation in the Event. Participant agrees that Participant will be solely responsible for the payment of all medical costs incurred for any such emergency treatment. Notwithstanding the foregoing, neither the Church nor the Diocese shall have any responsibility for security, protection from criminal acts, or medical or emergency services (whether on-site or off-site) to Participant in connection with the Event.
4. Consent to Authorize Photographs, Videos, and Recordings. Participant understands that Participant may be photographed, videotaped, and otherwise recorded while participating in the Event. Participant agrees on behalf of Participant that the Church and/or Diocese may use Participant’s name and likeness (in any form and without regard to distortions of character, form or color, or any other alteration) in photographs, videotapes, audiotapes, and other media, without providing any additional consideration to Participant or to any third party. Participant grants the Church and Diocese permission to utilize Participant’s name, image and/or likeness in any live or recorded audio, video or photographic display or other transmission or reproduction in whole or in part.
5. Arbitration. Participant agrees to submit any controversy, claim, or dispute arising from participation in the Event to binding arbitration administered by the American Arbitration Association, and judgment on the award rendered by the arbitrator may be entered in any court of competent jurisdiction in East Baton Rouge Parish, Louisiana. The arbitrator shall have full and exclusive authority to decide all issues regarding the arbitrability of any controversy, claim, or dispute arising out of or in any way related to the Event or Participant’s participation in any portion of the Event. Each party shall pay one-half the costs of arbitration. The arbitration proceeding shall proceed before a single arbitrator in East Baton Rouge Parish, Louisiana.
6. Severability . This Agreement shall be governed by the laws of the State of Louisiana. In the event that any provision of this Agreement shall be determined to be invalid or unenforceable for any reason, the remaining provisions of this Agreement shall be unaffected thereby and shall remain in full force and effect. Notwithstanding the foregoing, if any provision of this Agreement is held under any circumstances to be invalid or unenforceable in any jurisdiction, then (a) such provision or part thereof shall, with respect to such circumstances, be deemed amended to conform to applicable laws so as to be valid and enforceable to the fullest possible extent, (b) the invalidity or unenforceability of such provision or part thereof under such circumstances shall not affect the validity or enforceability of such provision or part thereof under any other circumstances or in any other jurisdiction and (c) such invalidity of enforceability of such provision or part thereof shall not affect the validity or enforceability of the remainder of such provision or the validity or enforceability of any other provision of this Agreement. Each provision of this Agreement is separable from every other provision of this Agreement, and each part of each provision of this Agreement is separable from every other part of such provision.
I HAVE READ THIS RELEASE OF LIABILITY, WAIVER OF CLAIMS, ASSUMPTION OF RISK, INDEMNIFICATION AND ARBITRATION AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, INCLUDING THE RIGHT TO PROCEED IN COURT, TO A JURY TRIAL, AND TO PUNITIVE DAMAGES AND EXEMPLARY, AND I SIGN IT FREELY AND VOLUNTARILY.
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Dr. Miss Mr. Mrs. Ms. Mx. Prof. Rev.
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