Registration

Event Participation, Liability Waiver, and Media Release Memorial Water Lantern Release

Thank you for participating in our memorial water lantern event, hosted by West Tennessee Healthcare (WTH). This event is designed to offer a time of reflection and remembrance for families who have experienced baby loss. To help ensure a safe and respectful experience for all, we ask each participant to review and sign the following waiver and release.

Participation & Safety Acknowledgment

By signing below, I acknowledge and agree to the following:

• I am voluntarily participating in the memorial water lantern event and assume all risks associated with such participation, including but not limited to: decorating and launching lanterns near water, participation in yard games or craft activities, minor slips, trips, or falls, and other risks associated with outdoor community gatherings.

• I also acknowledge that the event involves putting a lantern upon the water’s edge where there may be slippery surfaces, uneven terrain, or other potential risks. 

• I understand the risks involved with attending this event that may include, but are not limited to: falls, slips, contact and/or crashes with other attendees, injuries from contact with the fire, effects of weather including heat and/or humidity, cold, defective equipment, condition of the roads and/or festival area, rough terrain, storms, water hazards, hazards posed by spectators or other attendees, man-made or natural obstacles, any animals, insects, and poisonous plants.

• I understand that children may participate and that I, as parent or guardian (if applicable), am responsible for their supervision during the event.

• I agree to follow all posted instructions and any guidance given by WTH event staff and volunteers.

Liability Waiver

In consideration of being allowed to participate, I hereby waive, release, indemnify, and discharge WTH, its affiliates, employees, volunteers, sponsors, and agents from any and all claims, damages, or liabilities arising out of or related to my participation in the event, including personal injury, illness, property damage, or loss.

Media Release

I understand that photos and videos (including drone footage) will be taken at this event and may include my image or the image of my child(ren). All photographs, video, and audio recordings taken by or for WTH during this event are the property of WTH. By participating, I grant WTH and its representatives a non-exclusive, royalty-free, irrevocable license to use photographs, video, and audio recordings taken of me and/or my child(ren) at the event for promotional, marketing, publicity, and social media purposes in perpetuity, without compensation.

I understand that:

• Images may be used in print, digital, broadcast, and online media.

• I may request not to be photographed by notifying event staff, but it is my responsibility to do so.

• This release does not authorize use or disclosure of any protected health information or medical details about me or my family.

I understand that this media release does not expire unless revoked in writing. To revoke consent after the event, I may send a written request to:

Privacy Coordinator

West Tennessee Healthcare

620 Skyline Drive

Jackson, TN 38301

Minor Participation

If the participant is under 18 years of age, a parent or legal guardian must sign this form on the minor’s behalf. The undersigned affirms that he/she has legal authority to consent and agrees to the terms on behalf of the minor.