Release Form For Children's / Youth Events

PLEASE COMPLETE ALL FOUR SECTIONS OF THIS FORM

EVENT

Event Location: On the Church property, including the outdoor grounds, inside all buildings of the church, to and from the church, on filed trips, in the church vans, and any other area or location that will be necessary to carry out the event your child is participating in, while registered. This will also include all private residence’s and private vehicles used for church sponsored activities and events; whether on church owned property or not.

REGISTRATION

This is the participant.

MEDICAL RELEASE

Emergency Information:

Does participant have any allergies or other medical conditions or special needs? If yes, please list (use back if necessary)?

In case of emergency, whom should we contact?

I hereby authorize Church Alive and it’s representatives to seek medical attention for my child or ward should an emergency arise, provided that I will be contacted as soon as possible. Failure to reach me shall not prevent an application of immediate, necessary medical treatment, not excluding injection, anesthesia, or surgery.

AGREEMENT AND RELEASE OF LIABILITY

I certify that the information on this Registration Form, as entered by me, is truthful.


I, on behalf of myself, my heirs, assignees, and personal representatives, hereby release and forever discharge Church Alive, Waco, Inc. (DBA Church Alive) its employees, agents, members, sponsors, promoters, and affiliates from any and all liability, claim, loss, cost, or expense, and waive and promise not to sue on any such claims against any such person or organization, arising directly or indirectly from or attributable in any legal way to any negligence, action, or omission to act of any such person or organization or execution of this event, including travel to and from such event, in which my child or ward may participate.

I, as a parent or guardian of the above applicant, represent to Church Alive that the facts herein concerning my child or ward are true. I hereby give my permission for my child or ward to participate in the above named event, sanctioned by Church Alive and further, in consideration of granting permission,

Church Alive Mailing Address: 100 Zuni Dr. Hewitt, Texas 76643