BREAK OUT: New Creation Fellowship
Vacation Bible School Registration
JULY 27-31
9AM-NOON
For all kids ages 4 years- going into fifth grade.
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Name: *
Date Of Birth: *
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Age: *
Grade in the Fall: *
Parent/ Guardian Name(s): *
Address (Including City, State, and Zip code): *
Phone Number(s): *
Email(s):
Emergency Contact Information: *
Special Needs/ Allergies/ Concerns:
In consideration of New Creation Fellowship, I for myself, or the minor child named below, forever waive, release and discharge New Creation Fellowship from any/all injuries, claims, disputes, liabilities, or actions resulting from New Creation Fellowship providing services for me and for my benefit regardless of location for the dates identified above, except for injury or damage arising out of New Creation Fellowship’s negligence or willful misconduct. I attest and verify that I have full knowledge of the risks and dangers involved; that I assume such risks, and that I will assume and pay my own medical and emergency expenses, in the event of an accident, illness or other incapacity, regardless of whether I have authorized such expenses.Any controversy arising out of, connected to, or relating to any matters herein of the transactions between me and the above named parties or on behalf of the minor child named below, of this Release/Waiver, or the breach thereof, including, but not limited to any claims of violations of Federal and/or State Law, as well as any common law claims shall be settled by arbitration through Christian Conciliation Services; and in accordance with this paragraph a judgment based upon the arbitrator's award may be entered in any court having jurisdiction thereof in accordance with the provisions of R.C.W. 7.04. This agreement shall be construed and interpreted under the laws of the State of Washington.I HAVE READ THIS WAIVER AND RELEASE CAREFULLY, AND UNDERSTAND IT. *
Parent/ Guardian E-Signature/ Date *
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