Permission & Liability Release Form

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Participant's Name

 
 
 
 
 
 
Parent/Guardian Name

 
 
Emergency Contact #1

 
 
 
Emergency Contact #2

 
 
 
Medical Information

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Liability Release


We (I), being 21 years of age or older, do for ourselves (myself)and for and on behalf of my child -participant if said child is not 21 years of age or older) do hereby release, forever discharge and to hold harmless Kings Point Church of God and the directors thereof from any and all liability, claims or demands for personal injury, sickness or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by the undersigned and the child-participant that occur while said child is participating in the above-described trip activity. Furthermore, we (I)and on behalf or our (my) child-participate if under the age of 21 years) hereby assume ail risk of personal injury, sickness, death, damage and expense as a result of participation in recreation and work activities involved therein. The undersigned further hereby agree to hold harmless and indemnify said church, its directors, employees, and agents for any liability sustained by said church as the result of the negligent, willful or intentional acts of said participant.


I understand that in the event of a medical emergency, in case of injuries, accidents or illness, I give my permission for any treatment  deemed necessary in consultation between the attending emergency physician and the adult representative of Kings Point Church of God. 


 


I understand and do hereby verify that the above information is correct, and I do hereby release and forever discharge all sponsors and Kings Point Church of God from any and all claims, demands, actions or cause of action, past, present or future arising out of any damage or injury while participating in this church activity.


Authorization I have read, understand and agree with the Liability Release and Parental Consent Authorization. By typing my name I understand this is the act of a digital signature and release Kings Point Church of God from any and all liabilities.

 
 

Description

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