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Community Presbyterian Church of Brigantine Participation Waiver

Child First name

Child Last name

Child Date of birth

Month

Day

Year

Name of Adult who will be picking up your child(ren)

Emergency Contact Phone Number

Does your child have any restrictions or allergies? If yes, please list any restrictions to activity or other information relevant to child’s health history:

Waiver and release:

In consideration for my child(ren)’s attendance and participation in the programs offered by Presbyterian Church of Brigantine, I the parent/guardian acknowledge the existence of certain inherent risks in this type of program and hereby agree to assume all risks. I further relieve Presbyterian Church of Brigantine, it’s management, assigned staff, volunteers and fellow participants, and/or agents of the above from an liability resulting from loss, whether personal belongings or bodily injury on the premises. I also hereby state, that my child(ren) is/are physically fit to participate and do so of my own free will. I give permission for my child(ren) to be photographed and for those photos/videos to be used for marketing purposes such as social media and our website. I give permission to be added to the email list.

By signing below, I agree that I have read fully and understand the terms of this agreement, including the Waiver and Release stated on this agreement. By signing below, I acknowledge no receipt necessary of a completed copy of this contract.