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ASSUMPTION OF RISK, WAIVER AND RELEASE FORM

Skate-Ramp/Skateboarding, Surfing, Swimming & Other Activities including Jiu Jitsu and Pilates

(Form for Adult – Person Who is 18 or Older)


I EXPRESSLY UNDERSTAND AND ACKNOWLEDGE THAT SOME OF THE YOUTH, MINISTRY AND/OR OUTREACH ACTIVITIES OF NORTH PENINSULA BAPTIST CHURCH OF ORMOND BEACH, INC., A FLORIDA NOT FOR PROFIT CORPORATION D/B/A GRACELIFE BEACHSIDE (“GRACELIFE BEACHSIDE”) INCLUDE INHERENTLY RISKY OUTDOOR ACTIVITIES INCLUDING, BUT NOT LIMITED TO:

  • A “Half-pipe” Skate-Ramp located behind church building
  • Skateboarding in the parking lot/premises of Gracelife Beachside
  • Surfing at Adjacent Beach
  • Beach Activities (including swimming, boogie boarding, rafts, sports, campfires)
  • Jiu Jitsu and Pilates 
  • Games & Leisure Activities on the premises of Gracelife Beachside or adjacent Bicentennial Park (Volusia County Park)

The above-listed activities are hereinafter collectively referred to as the “GRACELIFE BEACHSIDE YOUTH and MINISTRY ACTIVITIES.”

INITIAL EACH OF THE FOLLOWING PARAGRAPHS:


 I expressly agree to participate in all the GRACELIFE BEACHSIDE YOUTH and MINISTRY ACTIVITIES.


 I do hereby forever agree, in consideration for the ability to participate in the GRACELIFE BEACHSIDE YOUTH and MINISTRY ACTIVITIES, to release, hold harmless and discharge GRACELIFE BEACHSIDE and its directors, officers, members, employees, volunteers, teachers, leaders, independent contractors, agents and/or sponsors, of any and all injuries (regardless of severity of injury), claims, demands, causes of action and legal liability, whether damages are known or unknown, arising in any way from my direct or indirect participation in the GRACELIFE BEACHSIDE YOUTH and MINISTRY ACTIVITIES.


I do further forever agree (on behalf of myself and my future guardian, personal representatives, heirs and/or beneficiaries, if applicable) and in consideration for the ability to participate in the GRACELIFE BEACHSIDE YOUTH and MINISTRY ACTIVITIES, not to bring any claims, demands, legal actions or causes of action against GRACELIFE BEACHSIDE and/or its directors, officers, members, employees, volunteers, independent contractors, agents and/or sponsors, for any economic or non-economic damages, costs, expenses and/or losses directly or indirectly attributable to any injury (physical or mental), paralysis, coma, death, theft, property damage arising in any way from my direct or indirect participation in the GRACELIFE BEACHSIDE YOUTH and MINISTRY ACTIVITIES.


   I have read and agree to follow the Skate Ramp Warning & Rules of Use which are conspicuously posted inside the Skate Ramp Area and/or otherwise provided to me separately in writing contemporaneously with this form.


   I understand and agree that I am participating at my own risk in the GRACELIFE BEACHSIDE YOUTH and MINISTRY ACTIVITIES.


 I assume full responsibility for any and all damages and liability that may directly arise from my participation in the GRACELIFE BEACHSIDE YOUTH and MINISTRY ACTIVITIES, not only to myself, but also to any other child/person (participating in said activities), the GRACELIFE BEACHSIDE church property and/or staff/volunteers.

           

 

 

 


First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Age Acknowledgment*
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.
Emergency Contact Information

1st Emergency Contact Person: Name:

Cell Phone Number:

Email:

Address

2nd Emergency Contact Person: Name:

Cell Phone Number:

Email:

Address (if different)
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*

Last Name*

Phone*
Parent or Guardian's Age Acknowledgment*
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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