Please list full names of anyone (including parents) who is allowed to pick up this child.
Please enter any custody concerns with your child you would like to share with us. Please type N/A if not applicable.
I give permission for photos of my child to be used in print and/or online at the discretion of Redeemer Bible Fellowship Church. I understand that my child will NOT be named or tagged in any photo.
In consideration of being allowed to participate in Topton Community Vacation Bible School sponsored by Redeemer Bible Fellowship Church of Topton, Pennsylvania and any related events and activities, and intending to be legally bound, the undersigned, whether the participant or his parent or legal guardian: 1. Acknowledges and fully understand that each participant may be engaging in activities that could involve risk of serious injury or death which might result not only from their own actions, inactions or negligence, but the action, inaction or negligence of others, or the condition of the premises or any equipment used; 2. Assumes all the foregoing risk and accept personal responsibility for the damages following such injury or death; 3. Releases, waives, discharges and covenants not to sue Redeemer Bible Fellowship Church of Topton, Pennsylvania, its employees, its pastor(s), its officers, deacons, elders and other leaders, its members, and anyone volunteering on its behalf (collectively, “Releasees”), from any and all liability to each of the undersigned, his or her heirs and next of kin for any and all claims, demands, losses or damages on account of injury, including death, or damage to property, caused or alleged to be caused in whole or in part by the negligence of the Releasees or otherwise; and 4. Authorizes the treatment of the participant by a qualified and license medical service provider in the event of a medical emergency which, in the opinion of the attending provider, may endanger their life, cause disfigurement, physical impairment, or undue discomfort if delayed, while said participant is engaged in the activity. This authority is granted only after a reasonable attempt has been made to contact the parent/guardian. I HAVE READ THE ABOVE AGREEMENT, UNDERSTAND THAT I GIVE UP SUBSTANTIAL RIGHTS BY SIGNING IT AND SIGN IT VOLUNTARILY.