Minor Release and Waiver of Liability

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Email *

I, the undersigned, certify that I am the parent or legal guardian of the minor child (hereafter the "minor child"). Type the child's name below. *

Legal Guardian's Name *

Legal Guardian's Email Address *

Legal Guardian's Phone Number *

Legal Guardian's Address *

Alternate Emergency Phone Number *

Important Allergy and/or medical information about the child: *

Please provide any additional information about your child that is important for the leaders to know. *

I consent for the minor child to participate with the China Regional Church of the Nazarene activity (hereafter "the activity"). Type the name of the activity below. *

On the following date(s) or during the timespan of: *

I recognize that there are risks involved in participating in these activities and hereby assume all risk of injury, harm, damage, or death to my minor child in connection with his/her participation in this activity. To the fullest extent permitted by law, I release China Regional Church of the Nazarene, its trustees, officers, employees, agents and representatives from any injury, harm, damage or death which may occur to my minor child while participating in the activity and agree to save and hold harmless China Regional Church of the Nazarene, its trustees, officers, directors, employees, agents and representatives from any claims arising out of my minor child's participation in the activity (Initial below). *

I recognize there are risks involved in participating in this activity and hereby assume all risk of injury, harm, damage, or death to my minor child in connection with his/her participation in this activity. To the fullest extent permitted by law, I release China Regional Church of the Nazarene, its trustees, officers, directors, employees, agents and representatives from any injury, harm, damage or death which may occur to my minor child while participating in the activity and agree to save and hold harmless China Regional Church of the Nazarene, its trustees, officers, directors, employees, agents and representatives from any claims arising out of my minor child's participation in the activity (Initial below). *

If you agree to all the statements and conditions in this form, sign this form electronically. Type your name below. *

I consent to China Regional Church of the Nazarene using my likeness or my minor child's likeness for use on its website and/or in promotional materials. *

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