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NEW BEGINNINGS (NB CHURCH) AGREEMENT & RELEASE FORM

Today's Date: July 18, 2018

I understand my child/I will be participating in all of the following activities, including but not limited to: Biblical teachings, outside basketball court games, inside and outside sports, Kid City Playscape activities and slide, train rides on a trackless train, obstacle courses, water sports, bounce houses, group activities, special activities that may involve food or animals such as live animal demonstrations and petting zoos, laser tag, and game competitions such as minute-to-win-it inside games, all Kid City week long camps, day camps and weekend camps, outside Fallfest and Summerfest activities, held at NB Church and agree not to hold NB Church or any of its members or staff responsible for any injury or loss incurred during Kid City time or events.

In case of an emergency, I give permission for my child/me to receive medical treatment.

I release and hold NB Church harmless from any injury, loss, or damage resulting from my childs/my participation in the above referenced activity, including any injury, loss, or damage arising from any act or omission of any, hotel, restaurant, or any other person or entity providing goods or services in connection with the activity.

;accept for acts or omissions that are willful or grossly negligent.

I agree to indemnify NB Church for all injury, loss, or damage to the person or property of others caused by my child/me.

I release and hold NB Church harmless from any liability for reasonable decisions or actions as may be taken to protect the health and safety of my child/me.

If in the event of an accident or emergency, I authorize NB Church to provide health care services to my child/me, at my expense, as deemed necessary, and I release and hold NB Church harmless from all liability resulting from such health care services;

and I agree that NB Church shall have the right to enforce appropriate standards of conduct and I authorize NB Church to take disciplinary or other action deemed reasonably necessary to maintain those standards. I recognize that violation of any such standards of conduct by my child/me may result in NB Church determining that I/we/he/she may no longer participate in the activity and I further understand it will be the Parent/Guardians responsibility to arrange transportation home for the child as soon as possible. In such event, we will not be entitled to any refund or reduction in fees or costs of the trip.

I understand that one or more photographers may be on the premises during this event and that photos and/or audio/video recordings may be taken and information about my child may be printed in the press or aired on television.

I give my permission to have my childs picture and name published in the press and hereby release in full NB Church and its agents, officers, and directors from any liability that may result from such publication.

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
I certify that I am 18 years of age or older
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Participant's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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