SportWaiver - BellevilleFirst

AMATEUR ATHLETIC WAIVER AND RELEASE OF LIABILITY

Please enable JavaScript in your browser to complete this form.

READ BEFORE SIGNING

In consideration of being allowed to participate in any way in Belleville First Assembly of God Church athletic sports program, related events and activities, the undersigned acknowledges, appreciates, and agrees that:
The risks of injury and illness from the activities involved in this program are significant, including the potential for permanent paralysis and death, and while particular rules, equipment, and personal discipline may reduce these risks, the risks of serious injury and illness do exist; and,
I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation; and,
I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately; and,
I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS Belleville First Assembly of God Church their officers, officials, agents, and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event (“RELEASEES”), WITH RESPECT TO ANY AND ALL INJURY, ILLNESS, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law.

FOR PARTICIPANTS OF MINORITY AGE (UNDER AGE 18 AT THE TIME OF REGISTRATION)

This is to certify that I, as parent/guardian with legal responsibility for this participant, have read and explained the provisions in this waiver/release to my child/ward including the risks of the activity and his/her responsibilities for adhering to the rules and regulations. Furthermore, my child/ward understands and accepts these risks and responsibilities. I for myself, my spouse, and child/ward do consent and agree to his/her release provided above for all the Releasees and myself, my spouse, and child/ward do release and agree to indemnify and hold harmless the Releasees from any and all liabilities incident to my minor child’s/ward’s involvement or participation in these activities as provided above, EVEN IF ARISING FROM THEIR NEGLIGENCE, to the fullest extent permitted by law.

All items below are required except the email address *** By checking the required box you agree to the above terms and rules.

Field #9 (copy)

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT

Full Name of Participant

First

Last

Age of Participant

Digital Signature of Participant

Please Include Your Full Name and Date

Full Name of Parent or Guardian

First

Last

Digital Signature and Date of Parent or Guardian

Please Provide your Full Name and Date Signed

Emergency Contact

Please Provide the Name and Phone Number of Your Emergency Contact

Please provide a good e-mail address

Welcome Home

Sunday @ 9:00am Adult Sunday School / 10:00 am Main Service

Wednesday @ 6:30pm Prayer Meeting and Worship