Dependent Information:


Emergency Contact #1:

Emergency Contact #2:

Transportation Release:

By initialing below, I agree to relinquish the church from any liability pertaining to transportation. Whether this in an official vehicle belonging to the church or a personal vehicle being used for church transportation purposes. Further, I waive my right to find or hold the person driving, the insurance of the driver, or owner/operator of the vehicle personally liable for any damages that may occur during transport.

Emergency Transportation Release:

In the event of a medical emergency, family emergency, and all other situations that would alter the transportation of other people, I acknowledge that I will have to find alternative transportation at my own expense.

Insurance Release:

I realize the church insurance begins where the individual health and accident policy terminates. It is only valid when all other insurance has been extended to its limits.

Personal Belongings Release:

I realize that the church or its sponsors are not responsible for personal belongings.

Personal Consent:

The undersigned realizes that the participant may incur personal injury or bodily damage while participating in such activities, and acknowledge that the church, it’s officers, directors, employees, agents, or any other parties volunteering on behalf of the church, shall be held harmless from all actions, claims, costs, expenses or damages of any kind, growing out of or related to any activities of the church. The undersigned further acknowledges this is a full and complete release for all injuries and damages which the participant may sustain as a result of participating in any activity.

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