Please print the following form, fill in your information and give to Greg or Amy Nash.

Liability Release Form

(Release of All Claims)

In consideration for being accepted by the Fayetteville Church of Christ for participation in 

 ________________________________________________________________________,
 (Name of trip or activity)

we (I), being 21 years of age or older, do for ourselves (myself) (and for and on behalf of our (my) child-participant, if said child is not 21 years of age or older) do hereby release, forever discharge and agree to hold harmless the Fayetteville Church of Christ, and the directors thereof from any and all liability, claims or demands for personal injury, sickness or death, as well as property damage and expense, of any nature whatsoever which may be incurred by the undersigned and the child-participant that occur while said child is participating in the above described trip or activity. 

Furthermore, we (I) (and on behalf of our (my) child-participant if under the age of21 years) hereby assume all risk of personal injury, sickness, death, damage and expense as a result of participation in recreation and work activities involved therein. 

Further, authorization and permission is hereby given to said church to furnish any necessary transportation, food and lodging for this participant. 

The undersigned further hereby agree to hold harmless and indemnify said church, its directors, employees and agents, for any liability sustained by said church as a result of the negligent, willful of intentional acts of said participant, including expenses incurred attendant thereto. 

(If the participant has not attained the age of21 years):

We (I) are the parent(s) or legal guardian(s) of this participant, and hereby grant our (my) permission for him (her) to participate fully in said trip, and hereby give our (my) permission to take said participant to a doctor or hospital and hereby authorize medical treatment, including but not in limitation to emergency surgery or medical treatment, and assume the responsibility for all medical bills, if any. 

Further, should it be necessary for the participant to return home due to medical reasons, disciplinary actions or otherwise, we (I) hereby assume all transportation cost.

_______________________________________
               (Print name of participant)

 Parents Phone Number  __________________________
(If participant is under 21 years)  

(Only participant need sign if 21 years of age or older. If under 21, both parents must sign unless parents are separated or divorced in which case the custodial parent must sign. )

______________________________________________________________________________
 (Participant, if age 21 or over)                                                                                     Date

 ______________________________________________________________________________     (Father)                                                                                                                         Date

 ______________________________________________________________________________     (Mother)                                                                                                                         Date

 ______________________________________________________________________________
(Legal Guardian)                                                                                                           Date

Trip Participant Only 

I have read the foregoing and understand the rules of conduct for participants and will abide by them as well as the directions of the leadership of this trip. 

______________________________________________________________________________
 (Participant)                                                                                                                  Date