PARTICIPANT/YOUTH/CHILD LIABILITY WAIVER AND RELEASE FORM

THIS FORM MUST BE COMPLETED BEFORE ANY PARTICIPATION WILL BE ALLOWED

Parent/Guardian’s Information:

Participant/Youth/Child’s Information:

I certify that I am the parent or legal guardian of the above participant and that I am entitled to his/her custody and control and I do hereby give permission for the Youth/Child to participate in all activities. I further certify that the Youth/Child is in good health and has no physical or other impediment which would endanger him/her while participating in any activities. I realize that by participating in these activities, the Youth/Child will be exposed to a risk of injury or death. I understand the dangers incidental to participating and the need for safety precautions, and I have discussed the dangers of the program and the need for safety precautions with the Youth/Child. I hereby execute the below Liability Waiver and Release on his/her behalf.
I certify that I am volunteering to participate in all activities hosted/sponsored by The Pentecostals of York either on the property of The Pentecostals of York or offsite at a designated place.

I further certify that I am in good health and have no physical or other impediment which would endanger me while participating in any of these activities. I will not be under the influence of drugs or alcohol, which would impair my ability. I acknowledge and agree that all these activities have inherent risks. I have full knowledge of the nature and extent of all the risks associated with these activities.

In consideration of my participation in this activity, I agree (on behalf of myself, my heirs, executors, administrators, and assigns) to release, discharge, waive and relinquish The Pentecostals of York (or its officers, agents, employees and volunteers) from any and all liabilities, claims, or actions for personal injury, property damage, or wrongful death which may arise out of my participation.
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