Permission Form - "Treasured" VBS
Sign in to Google to save your progress. Learn more
Activity Participation Agreement
Paw Paw Bible Church 412 7th St. Paw Paw IL. 61353
Phone: 630-803-7252
Coordinator: Michelle Hilleson
Phone: 815-761-4450

All activities at Vacation Bible School
July 12-16th at Paw Paw Bible Church
Participant Information (To be completed by participant or authorized guardian)
Name of participant:
Address
Name of parents/guardians
Telephone
Name of emergency contact:
Telephone (daytime):
Telephone (evening):
List allergies or medical conditions:
Is sponsor authorized to approve medical treatment?
Clear selection
Is participant covered by personal/family medical insurance?
Clear selection
If yes, name of insurer:
Policy or group number:
Participation Agreement
I acknowledge that participation in the activity described above involves risk to the participant (and to the participant’s parents or guardians, if the participant is a minor), and may result in various types of injury including, but not limited to, the following: sickness, bodily injury, death, emotional injury, personal injury, property damage, and financial damage.
In consideration for the opportunity to participate in the activity described above (the “activity”), the participant (or parent/guardian if the participant is a minor) acknowledges and accepts the risks of injury associated with participation in and transportation to and from the activity. The participant (or parent/guardian) accepts personal financial responsibility for any injury or other loss sustained during the activity or during transportation to and from the activity, as well as for any medical treatment rendered to the participant that is authorized by the sponsor or its agents, employees, volunteers, or any other representatives (collectively referred to as the “activity sponsor”). Further, the participant (or parent/guardian) releases and promises to indemnify, defend, and hold harmless the activity sponsor for any injury arising directly or indirectly out of the described activity or transportation to and from the activity, whether such injury arises out of the negligence of the activity sponsor, the participant, or otherwise.
If a dispute over this agreement or any claim for damages arises, the participant (or parent/guardian) agrees to resolve the matter through a mutually acceptable alternative dispute resolution process. If the participant (or parent/guardian) and the activity sponsor cannot agree upon such a process, the dispute will be submitted to a three-member arbitration panel for resolution in accordance with the rules of the American Arbitration Association.

Please type your name to act as your signature.
Childs Signature
Date
MM
/
DD
/
YYYY
Parents Signature
Date
MM
/
DD
/
YYYY
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy