Trip Or Activity Liability Release Form With Permission To Search Belongings printable pdf download

Liability Release Form

Release of All Claims

In consideration for being accepted by Northwood Community Church for participation in

___________________________, we (I) being 21 years of age or older, do for ourselves (myself) (and

for and on behalf of my child-participant if said child is not 21 years of age or older) do hereby release,

forever discharge and agree to hold harmless Northwood Community Church and the directors thereof

from any and all liability, claims or demands for personal injury, sickness or death, as well as property

damage and expenses, of any nature whatsoever which may be incurred by the undersigned and the

child-participant that occur while said child is participating in the above described trip or activity.

Furthermore, we (I) [and on behalf of our (my) child-participant if under the age of 21 years]

hereby assume all risk of personal injury, sickness, death, damage and expense as a result of

participation in recreation and work activities involved therein.

Further, authorization and permission is hereby given to said church to furnish any necessary

transportation, food and lodging for this participant.

The undersigned further hereby agree to hold harmless and indemnify said church, its directors,

employees and agents, for any liability sustained by said church as the result of the negligent, willful or

intentional acts of said participant, including expenses incurred attendant thereto.

(If the participant has not attained the age of 21 years):

We (I) are the parents or legal guardian(s) of this participant, and hereby grant our (my)

permission for him (her) to participate fully in said trip, and hereby give our (my) permission to take

said participant to a doctor or hospital and hereby authorize medical treatment, including but not in

limitation to emergency surgery or medical treatment, and assume the responsibility of all medical

bills, if any.

In addition, we (I) authorize representatives of said church to conduct a search of participants’

belongings at said representatives’ discretion. Further, should it be necessary for the participant to

return home due to medical reasons, disciplinary action or otherwise, we (I) hereby assume

responsibility for transportation and/or the expense thereof.

______________________________________

(Print Name of Participant)

Father

Date

______________________________________

(Parent’s Phone)

Mother

Date

______________________________________

Legal Guardian

Date

Hospital Insurance: __ Yes __ No

Insurance Company:

______________________________________

Participant, if age 21

Date

Policy Number _________________________

Trip Participant Only:

Physician ______________________________

I have read the foregoing and understand the

Physician’s Phone _______________________

rules of conduct for participants and will abide

by them as well as the directions of the

Emergency Phone Numbers

leadership of the trip.

______________________________________

Participant

______________________________________

Trip Or Activity Liability Release Form With Permission To Search Belongings

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