Parent/Guardian *

First Name

Last Name

Phone *

(###)

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Emergency Contact *

First Name

Last Name

Phone *

(###)

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Participant 1 *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Participant 2

First Name

Last Name

Date of Birth

MM

DD

YYYY

Participant 3

First Name

Last Name

Date of Birth

MM

DD

YYYY

Liability Release *

I acknowledge and agree that I am 18 years or older, and do release for myself, and if applicable for or on behalf of my child participant(s), if under the age of 18 years, do hereby release, discharge and agree to hold harmless Gracepoint North Church and the elders and staff (“Gracepoint Indemnitees'') from any and all liability, claims or demands for personal injury, sickness or death, as well as property damages and expenses, of any nature whatsoever which may be incurred by the undersigned and/or the child participant(s) that occur while participating in Vacation Bible School. Furthermore, I (and for or on behalf of my minor child or children) hereby acknowledge that there is risk of personal injury, sickness, death, damage and expense as a result of participation in recreation and activities involved and assume the risks. Additionally I give authorization and permission to the retreat organizers to furnish and hereby release from liability arising from transportation, food and lodging for myself and child participant(s) as applicable. I further agree to hold harmless and indemnify Gracepoint North Church Indemnitees, for any liability sustained by them as the result of negligent, willful or intentional acts of myself or the child participant, including expenses incurred attendant thereto. Applicable for those under the age of 18 - As the parent(s) or legal guardian(s) of this participant, and hereby grant our (my) permission for him/her to participate fully in said event and hereby give our permission to take said participant to a doctor or hospital and hereby authorize medical treatment, including but not limited to emergency surgery or medical treatment, and assume the responsibility of all medical bills, if any. Further, should it become necessary for the participant to return home due to medical reasons, disciplinary action or otherwise, I (we) hereby assume all transportation costs.

I have read and agree to the Liability Release

Social Media Consent *

Cornerstone Church, Gracepoint Church, and Gracepoint North Church would like your permission to use your image on our public social media platforms. Please indicate your consent below.

Yes

No