Trip Or Activity Liability Release Form (18 Years Of Age Or Older)

ADVERTISEMENT

LIABILITY RELEASE FORM
Release of All Claims
In consideration for being accepted by St. Andrew Presbyterian Church for participation
in____________________ (Name of trip or activity) we/I, being 18 years of age or older, do ourselves/myself
(and for and on behalf of my child-participant if said child is not 18 years of age, or older) do hereby release,
forever discharge and agree to hold harmless St. Andrew Presbyterian Church and the directors thereof from
any and all liability, claims of 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 18 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 agrees 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 18 years):
We/I are/am the parent(s) or legal guardian(s) of this participant, and hereby grant our/my permission for
him/her to participate fully in said trip or activity, 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.
Further, should it be necessary for the participant to return home due to medical reasons, disciplinary
action or otherwise, we/I hereby assume all transportation costs.
(Only participant need sign if 18 years of age or older. If participant is under 18, both parents must sign
unless parents are separated or divorced in which case the custodial parent must sign.)
Date:________________
Name of Participant___________________________________
Signatures:
Father__________________
Mother____________________
Legal guardian________________________________________
Participant, if age 18___________________________________
Parent(s) telephone_________________________
Pastor’s telephone_______________________
Hospital Insurance ___Yes ___No Name of Insurance Co.____________________________________
Policy number_________________________
Physician___________________________________ Physician’s phone___________________________
Emergency phone #’s___________________________________________________________________
Trip/Activity Participant Only
I have read the foregoing and understand the rules of conduct for participants and will abide by them as
well as the directions of the leadership of the trip.
Participant signature___________________________________________

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Legal
Go