Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Liability Waiver *

Liability Release and Parental Consent Form In order for my child to participate in the Church on the Hill kids summer Camp program, I hereby waive, release, and discharge any and all claims for damages for personal injury, and property damages or which may hereafter occur to me or my child(ren) as a result of participation in said event. This release is intended to discharge in advance the Church on the Hill and Highland Valley Baptist Church, its officials, officers, employees, volunteers and agents from liability, even though that liability may arise out of perceived negligence on the part of persons mentioned above. It is understood that some recreational activities involve an element of risk or danger of accidents, and knowing those risks, I hereby assume those risks. It is further understood and agreed that this waiver, release and assumption of risk is to be binding on my heirs and assignees.

Yes

Parent(s) Name

Please put your name here and check the box below to give consent.

First Name

Last Name

Parental Consent (if under 18) *

Parental Consent (Complete if applicant is under 18) I give consent for my child to participate in the above activities, and I execute the above liability release on their behalf. Consent for Treatment I hereby give my consent to have the above applicant treated by emergency medical personnel, a physician, or surgeon, in case of sudden illness or injury while participating in the above activity. It is understood that Church on the Hill and Highland Valley Baptist church will provide no medical insurance for such treatment, and that the cost thereof will be at my expense. I have read and understood the foregoing registration liability release and parental consent form, and agree to all of its terms and conditions.

Yes

N/A