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  1. I hereby RELEASE, WAIVE, AND DISCHARGE GRACE CHRISTIAN FELLOWSHIP CHURCH, its agents, servants and employees (hereinafter referred to as RELEASEES) from any and all liability, claims, demands, actions and causes of action whatsoever arising out of or related to any loss, damage, or injury, including death, that may be sustained by me, my children or any of the property belonging to me or my children, WHETHER CAUSED BY THE NEGLIGENCE OF THE RELEASEES, or otherwise, while participating in such Activity, or while in, on or upon the premises where the Activity is being conducted.
     
  2. I am fully aware of the unusual risks involved and hazards connected with this Activity, including but not limited to travel risks and/or injury or death. I hereby elect to voluntarily participate and/or allow my children to participate in said Activity with full knowledge that said Activity may be hazardous to me and/or my children. I VOLUNTARILY ASSUME FULL RESPONSIBILITY FOR ANY RISKS OF LOSS, PROPERTY DAMAGE OR PERSONAL INJURY, INCLUDING DEATH that may be sustained by me and/or my children or any loss or damage of property owned by me and/or my children, as a result of being engaged in such Activity, WHETHER CAUSED BY THE NEGLIGENCE OF RELEASEES OR OTHERWISE.
     
  3. I further hereby AGREE TO INDEMNIFY AND HOLD HARMLESS the RELEASEES from any loss, liability, damage or costs, including court costs and attorney fees, that they may incur due to my participation and/or the participation of my child in said Activity, WHETHER CAUSED BY NEGLIGENCE OF RELEASEES or otherwise.
     
  4. I understand that the RELEASEES may not maintain any insurance policy covering any circumstance arising from my participation in this Activity or any event associated with or facilitating that participation. As such, I am aware that I should review my personal insurance portfolio.
     
  5. It is my express intent that this Waiver of Liability and Hold Harmless Agreement shall bind the members of my family and spouse, if I am alive, and my heirs, assigns and personal representative, if I am deceased, and shall be deemed as a RELEASE, WAIVER, AND DISCHARGE of the above-named RELEASEES. I hereby further agree that this Waiver of Liability and Hold Harmless Agreement shall be construed in accordance with the laws of the State of Texas. 
     
  6. IN SIGNING THIS RELEASE, I ACKNOWLEDGE AND REPRESENT that I have read the foregoing Waiver of Liability and Hold Harmless Agreement, understand it, and have signed it voluntarily as my own free act and deed; no oral representations, statements, or inducements, apart from the foregoing written agreement, have been made; I am at least eighteen (18) years of age and fully competent; and I execute this Release for full, adequate and complete consideration fully intending to be bound by same. I understand that if a Participant is under the age of 18 and in case of accident, I give the RELEASEES authorization to seek reasonable and necessary medical treatment for myself and/ or my children during such Activity or associated event, and I agree to be responsible for any cost of such treatment.

August 22, 2019

Please select who will be participating...
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First Participant's Name

First Name*

Last Name*
First Participant's Date of Birth*
I certify that I am 18 years of age or older
First Participant's Information

Name of the Church Activity your child is participating in *

Father's Name

Father's Phone Number

Mother's Name

Mother's Phone Number

Insurance Provider

Insurance Policy Number

List Medications

Known Allergies
First Participant's Signature*
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*
A signed copy of this waiver will be sent to the email address you provide.
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
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*

Relationship*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Information

Name of the Church Activity your child is participating in *

Father's Name

Father's Phone Number

Mother's Name

Mother's Phone Number

Insurance Provider

Insurance Policy Number

List Medications

Known Allergies
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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