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Local Event Agreement & Release

I give my permission for Myself

to attend the Celebrate America event at New Beginnings Church on Sunday, July 2nd, 2023.

 

I understand my child and/or I will be participating in any and/or all activities available during the Celebrate America Event, including special activities that may involve food/water/bounce houses/dunk tanks/ climbing wall and zip lines.

 

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 me and or my child, at my expense, as deemed necessary

 

I understand that one or more photographers may be on the premises during this event and give my permission for any photos and/or audio/video recordings of me and/or my child to be published, including on the web 


 

I understand this Agreement and Release and release in full NB Church, its agents, officers, and directors from any liability that may result from any injury, damage or loss incurred during the event

 

Participant (if over 18 yrs old)

Print Full Name Fields

 

Date April 24, 2024

 

 

Parent/Legal Guardian full Name: Fields

Relationship to child: Fields

Date April 24, 2024


I give my permission for my Children:

 



First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

Last Name*
Tenth Participant's Date of Birth*
Parent or Guardian's Email Address

Email*

Confirm Email*
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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.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Phone*
Parent or Guardian's Date of Birth*
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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