Minor Release and Waiver of Liability
Please fill out this form and click submit before the event.
Please fill out a separate form for each child.
I, the undersigned, certify that I am the parent or legal guardian of the minor child (hereafter the “minor child”). Type the child's name below.
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Legal Guardian's Name
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Legal Guardian's Email Address
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This address will receive a confirmation email
Legal Guardian's Phone Number
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Alternate Emergency Phone Number
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Important Allergy and/or medical information about the child:
Please provide any additional information about your child that is important for the leaders to know.
I consent for the minor child to participate with the Lombard Church of the Nazarene activity (hereafter “the activity”). Type the name of the activity below.
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Enter the year for which this consent form applies.
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Enter the date or date range for which this form applies (you can enter dates that cover up to one year).
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I recognize that there are risks involved in participating in this activity and hereby assume all risk of injury, harm, damage, or death to my minor child in connection with his/her participation in this activity. To the fullest extent permitted by law, I release Lombard Church of the Nazarene, its trustees, officers, directors, employees, agents and representatives from any injury, harm, damage or death which may occur to my minor child while participating in the activity and agree to save and hold harmless Lombard Church of the Nazarene, its trustees, officers, directors, employees, agents and representatives from any claims arising out of my minor child’s participation in the activity (Initial below).
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I recognize that there are risks involved in participating in this activity and hereby assume all risk of injury, harm, damage, or death to my minor child in connection with his/her participation in this activity. To the fullest extent permitted by law, I release Lombard Church of the Nazarene, its trustees, officers, directors, employees, agents and representatives from any injury, harm, damage or death which may occur to my minor child while participating in the activity and agree to save and hold harmless Lombard Church of the Nazarene, its trustees, officers, directors, employees, agents and representatives from any claims arising out of my minor child’s participation in the activity (Initial below).
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If you agree to all of the statements and conditions in this form, sign this form electronically. Type your name below.
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I consent to Lombard Church of the Nazarene using my child's likeness for use on its website and/or in promotional materials.
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Please select all that apply.
Yes
No
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Description
Please fill out this form and click submit before the event.
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