As you register, you will be asked to initial that you read all of the below:
I, the undersigned parent/guardian, hereby consent to my child, ____________________________ who is _________ years of age, participating in activities connected with BETHANY COMMUNITY CHURCH and KNOCKERBALL PEORIA LLC in Washington, IL. I certify that my child is able to participate in these activities including sports, hiking, Knockerball, bounce houses, hay rack rides, activities around animals, etc. (unless otherwise indicated). If there are any activities I do not want my child to be involved in I have listed them.
I UNDERSTAND AND HEREBY AGREE TO ASSUME ALL OF THE RISKS WHICH MAY BE ENCOUNTERED ON SAID ACTIVITIES, INCLUDING ACTIVITIES PRELIMINARY AND SUBSEQUENT THERETO.
If my child has medical conditions, which may be relevant to a physician in the event of an emergency, I have listed them. In the event that an emergency occurs, I may be reached at the telephone number(s) listed. If I cannot be reached within a reasonable period of time, I hereby authorize the Bethany Community Church staff to make emergency medical decisions for my child. I consent to the use of my child’s portrait or picture for purposes of trade, publicity, and or information by BETHANY COMMUNITY CHURCH or KNOCKERBALL PEORIA LLC.
I do hereby agree to hold BETHANY COMMUNITY CHURCH and KNOCKERBALL PEORIA LLC and its agents and employees, harmless from any and all liability, actions, causes of action, claims, expenses, and damages on account of injury to my child or property, even injury resulting in death, which I now have or which may arise in the future in connection with the activity and participation in any other associated activities. I expressly agree that this release, waiver, and indemnity agreement is intended to be broad and inclusive as permitted by the State of Illinois law and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. This release contains the entire agreement between the parties hereto, and the terms of this release and contractual and to a mere recital. I further state that I HAVE CAREFULLY READ THE FOREGOING RELEASE AND KNOW THE CONTENTS THEREOF AND I SIGN THIS RELEASE AS MY OWN FREE ACT. This is a legally binding agreement, which I have read and understand.
Parent/Guardian’s Signature ____________________________________________________ Date _____________________
