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Welcome to the 2026 Back-to-School Health Fair hosted by Origin Church! Please complete the following Health-Fair Participant Consent & Waiver Form to receive services.

Name
Address
Gender
Are you currently under a healthcare provider’s care?
Services You Are Seeking Today (check all that apply):
Clear Signature
Health Fair Participation Acknowledgment and Waiver of Liability: By signing above, I acknowledge my voluntary participation in the Back-to-School Health Fair hosted by Origin Ministries, Inc. d/b/a Origin Church, whether as a service recipient, vendor, or volunteer. I understand that any screenings or services offered are educational and limited in scope, and do not replace medical diagnosis or treatment by a licensed healthcare provider. I understand that no provider-patient relationship is created through participation, and any screening results are preliminary and may not detect all conditions. I accept full responsibility to consult my personal healthcare provider regarding any findings or concerns. I consent to health screenings, including potential blood or body fluid testing, and acknowledge minor risks such as discomfort, bruising, or rare exposure to biohazards. I assume all risks associated with my participation, including those related to physical activity, health screenings, and communicable diseases. I release and hold harmless Origin Church, its employees, volunteers, agents, participating healthcare providers, and affiliated organizations from any claims, injuries, or losses arising out of or related to my participation, including the use or interpretation of screening results or failure to follow up. If signing on behalf of a minor, I consent to their participation, including immunizations, school physicals, and related services. I understand that CPR demonstrations may involve physical contact and consent to participation with that understanding. I authorize Origin Church to use any photographs or video taken of me or my dependents during the event for promotional purposes worldwide and in perpetuity. I understand that personal and health information will be collected and protected in accordance with applicable privacy laws. I agree to follow all safety protocols and emergency procedures in place at the event. By signing, I confirm that I have read, understood, and voluntarily accept the terms of this waiver.