Summer Blast Registration

Parent's Name *
Parent's Name
Parent's Phone *
Parent's Phone
Msg & Data rates may apply.
Emergency Contact Name *
Emergency Contact Name
Emergency Contact Phone *
Emergency Contact Phone
Activity Release
I wish to enroll my child or legal ward in Summer Blast 2019 (“activity” or “activities”), an activity of New Life Community Church’s children’s ministry (the “Church”), in consideration, I, acknowledge and agree that: 1. I am the parent/guardian with legal responsibility for my child/ren registered above (“Child”) and I have given my consent to the Church for my Child to enroll in this activity. I am aware of the physical risks my Child faces due to the active nature of this activity. I understand that the actions of my Child cannot be controlled at all times. 2. I hereby certify that I am at least eighteen (18) years of age and legally competent to sign this waiver on behalf of my Child. 3. I agree that my signing this agreement is entirely voluntary. 4. I understand this agreement is binding not only on me, but also on my respective representative heirs. 5. I hereby certify that my Child is able to enroll in this activity of the Church. I understand it is my obligation to inform the Church of any and all health considerations or medical conditions that would restrict my Child’s involvement in the activities. 6. I personally assume all risk in connection with my enrolling of my Child in the Church’s activities for any harm, injury, or damages that may befall my Child as a result of my enrolling of my Child in the Church’s activities, whether foreseen or unforeseen, and I still wish to enroll my Child in the activities. I hereby voluntarily release and forever discharge and agree to indemnify and hold harmless the Church from any and all liability and responsibility for any loss, damage, or injury of any kind that I or my Child may suffer as a result of or in any way connected with the enrollment in the activity. This release covers any loss, damage or injury caused by: a) Any criminal, illegal or unauthorized acts of third parties; b) Any injury or assault that may occur due to the actions of one of the minors enrolled in the activities; c) Any injury that may occur due to my Child by a volunteer or employees’ during their service for the Church; d) Any conditions, developments, actions or omissions outside of the control of the Church; e) Any other expected or unexpected conditions, developments or risks connected with volunteer service for minors with special needs, even if I or my Child suffer the loss of money, property, health, or life, and irrespective of who is or may be at fault, or whose negligence, including the negligence of the Church, may have caused loss, injury or death. 7. If my Child needs medical attention while attending Church’s activities, I give the Church, its employees and volunteers, permission to seek medical diagnosis and treatment which in their best judgment they deem to be necessary or appropriate under the circumstances. I understand I am financially responsible for all medical and transportation expenses incurred as a result of the use of this consent. 8. I consent to the use my Child’s photograph, likeness, image, voice or performance on the Church’s internet website, CD or DVD labels, video tape or film clips, advertisements or other official Church publications at the sole discretion of the Church. 9. I agree that any claim or dispute arising from or related to this agreement, other than a claim for injunctive relief as otherwise provided in this Agreement, shall be settled by mediation or arbitration in Jefferson County, Alabama, in accordance with the then governing Rules of Procedure for Christian Conciliation of the Institute for Christian Conciliation. In the event that the Institute for Christian Conciliation ceases to exist during the course of this Agreement, arbitration under this section shall be conducted according to the rules of the American Arbitration Association. Judgment upon an arbitration award may be entered in any court of competent jurisdiction. I agree that each party, myself and the Church, shall bear our own costs related to any other medical or arbitration proceeding. 10. I have fully informed myself of the contents of this WAIVER OF LIABILITY by reading it before I signed it. PARENT OR GUARDIAN: I agree that we both shall be bound by this Agreement.
I have read the above Activity Release Statement and will sign my name below. *
I have read the above Activity Release Statement and will sign my name below.
Child 1 Name *
Child 1 Name
Child 1 DOB *
Child 1 DOB
Child 2 Name
Child 2 Name
Child 2 DOB
Child 2 DOB
Child 3 Name
Child 3 Name
Child 3 DOB
Child 3 DOB
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