Event Registration Form

Student's Name *
Student's Name
Confidential
Parent's Name *
Parent's Name
Emergency Contact *
Emergency Contact
Different than parent listed above
Waiver *
WAIVER, RELEASE, AND ASSUMPTION OF THE RISK I (We) acknowledge that my child’s participation in Covenant Presbyterian Church (CPC) activities is voluntary and may require traveling or physical exertion. Such activities may include, but are not limited to: outings, athletic games, local excursions and meetings, and other activities. I (We) acknowledge that my child’s participation in any CPC youth activity presents risks that I or my child may suffer including, but not limited to, damage to personal property, financial damage, emotional injury, illness, bodily injury, or death. I (we) hereby assume those risks. And, in consideration of my child’s being allowed to participate in the CPC youth program activities, I (we) agree and take the following actions for me and my child: I (we) waive, release, and discharge CPC, its pastors, directors, officers, members, employees, volunteers, representatives, subcontractors, and agents from any and all claims for: (A) Financial losses, including (but not limited to) insurance deductibles and medical expenses, that we as parents or guardians must pay as a result of injury or illness arising out of activities sponsored by CPC; (B) Damage, destruction, loss or theft of personal belongings of the minor participant or parents of the same; and (C) Any claims or liabilities that I (we) may assert as parents for loss of consortium, death or personal injury, which arise out of or relate to my child’s participation in CPC’s youth activities; and, to the extent allowable by law, all similar or identical claims that my child may assert. Notwithstanding any of the foregoing, CPC is not released from any claims or liabilities that are caused solely by CPC. I (we) agree not to sue any of the persons or entities mentioned above for any of the claims or liabilities that I have waived, released, or discharged herein. I (we) indemnify and hold harmless the person or entities mentioned above from any claims made or liabilities assessed against them as a result of my child’s actions. I agree to indemnify and hold harmless the person or entities mentioned above for any claims or liabilities assessed against them as a result of any inaccuracy in the information provided to CPC. I hereby execute this document for and on behalf of the minor named herein. By way of signature, please choose I Agree if you consent to the WAIVER, RELEASE, AND ASSUMPTION OF THE RISK.