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Sports Waiver 2021-22

WAIVER & INDEMNITY AGREEMENT

IN CONSIDERATION OF being permitted to participate in Springvale Baptist Church - Sports, I the undersigned participant, hereby release and undertake and agree to save harmless and keep indemnified Springvale Baptist Church, its principals, officers, agents, officials, servants, organizers and representatives from and against all claims, actions, costs and expenses and demands whatsoever in respect of death, injury, loss or damage to my person or property, howsoever caused, arising out of or in connection with my participation in Springvale Baptist Church - Sports and regardless of whether same may have been contributed to or occasioned by the negligence of Springvale Baptist Church, its principals, officers, agents, officials, servants, organizers and representatives.

 It is hereby acknowledged that the contents hereof are fully understood by the Participant who agrees that same shall be binding upon (his/her/their) heirs, successors, executors, administrators and assigns.

Participant is over the age of 18 years.

I Agree

Participant is under the age of 18 years

I Agree
(form must be completed by a parent or guardian)

Participant agrees to adhere to all COVID-19 guidelines as outlined by the church. 

I Agree

Today's Date: May 28, 2022


First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information

MEDICAL INFO (Please indicate any allergies, health problems, medications, or other health concerns) or type N/A *
First Participant's Signature*
Second Participant's Name

First Name*

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

MEDICAL INFO (Please indicate any allergies, health problems, medications, or other health concerns) or type N/A *
Third Participant's Name

First Name*

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

MEDICAL INFO (Please indicate any allergies, health problems, medications, or other health concerns) or type N/A *
Fourth Participant's Name

First Name*

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

MEDICAL INFO (Please indicate any allergies, health problems, medications, or other health concerns) or type N/A *
Fifth Participant's Name

First Name*

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

MEDICAL INFO (Please indicate any allergies, health problems, medications, or other health concerns) or type N/A *
Sixth Participant's Name

First Name*

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

MEDICAL INFO (Please indicate any allergies, health problems, medications, or other health concerns) or type N/A *
Seventh Participant's Name

First Name*

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

MEDICAL INFO (Please indicate any allergies, health problems, medications, or other health concerns) or type N/A *
Eighth Participant's Name

First Name*

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

MEDICAL INFO (Please indicate any allergies, health problems, medications, or other health concerns) or type N/A *
Ninth Participant's Name

First Name*

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

MEDICAL INFO (Please indicate any allergies, health problems, medications, or other health concerns) or type N/A *
Tenth Participant's Name

First Name*

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

MEDICAL INFO (Please indicate any allergies, health problems, medications, or other health concerns) or type N/A *
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 Springvale's weekly e-Newsletter
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Sport Attending
Please choose any or all sports of choice
Basketball (Monday)
Volleyball (Tuesday)
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*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information

MEDICAL INFO (Please indicate any allergies, health problems, medications, or other health concerns) or type N/A *
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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