ABUNDANT LIFE BAPTIST CHURCH

PARENTAL RELEASE WAIVER & INDEMNITY AGREEMENT

(Print Minor’s Legal Name)_____________________________ (hereafter referred to as the “minor”) does hereby state that the “minor” wishes to participate in activities sponsored by the Abundant Life Baptist Church in Washington, Pennsylvania (hereafter referred to as “ALBC”) by attending the Youth Group outing to ____________________________________________________________________.

It is the desire of “ALBC” to provide a safe and enjoyable experience for the youth in a setting conducive to developing and strengthening personal relationships with Jesus Christ our Lord and Savior. It is a fact, however, that participating in youth group activities carries with it a certain risk of personal injury and/or property damage. By participating in these activities the “minor’s” parent and/or guardian voluntarily accepts and assumes this risk as follows.

For and in consideration of permitting “minor” to observe, or use any facility or equipment of “ALBC” or engage in and/or receive instruction in any activity or activity incidental thereto some of which may involve dangers and risk of bodily injury while at “ALBC” or in transit to and from “ALBC” and to and from the site of planned activities, the undersigned parent and/or guardian hereby voluntarily and absolutely releases, discharges, waives and relinquishes any and all loss or damages or actions or causes of action for personal injury, property damage, or wrongful death occurring to “minor” as a result of “minor’s” observing or using facilities or equipment of “ALBC” and/or being transported, or engaging in or receiving instruction in any activities some of which may involve dangers and risk of bodily injury or in activities incidental thereto wherever or however the same may occur, and for whatever period said activities or instructions may continue.

It is the intention of the undersigned parent or legal guardian of “minor” by this agreement to exempt and relieve “ALBC” and its officers, agents, servants, or employees from liability for personal injury, property damage, or wrongful death of minor caused by any act of negligence of “ALBC” and its officers, agents, servants, or employees.

The undersigned parent or guardian of “minor” for him/herself, his/her heirs, executors, administrators, or assigns agrees that in the event any claim for personal injury, property damage, or wrongful death shall be prosecuted against “ALBC” or its officers, agents, servants, or employees, the undersigned parent or guardian will indemnify and hold harmless “ALBC” and/or its officers, agents, servants, or employees from any and all claims or causes of action by “minor” or by any other person or entity, by whomever or wherever made or presented, and under no circumstances will the undersigned parent or guardian of “minor” present any claim against “ALBC” or its officers, agents, servants or employees for personal injuries, property damage, wrongful death or otherwise caused by any act of negligence by “ALBC” or its officers, agents, servants or employees.

The undersigned Parent and/or Guardian represents that he/she has read this release and understands the terms and the legal consequences of the signing of this release. The undersigned Parent and/or Legal Guardian intends his or her signature to be a complete and unconditional release of all liability to the greatest extent allowed by law and if any portion of the release is held invalid, it is agreed that the balance shall, not withstanding, continue in full legal force and effect.

________________________________________ _______________________________

Name of “Minor” (PRINT) Date of Birth

________________________________________ ___________________ ___________

Home Address (Street) City State

_______________________________ ______________________________ ___________

Parent/Legal Guardian Name (PRINT) Parent/Legal Guardian Signature Date

PARENT PERMISSION FORM

FOR STUDENT PARTICIPATION IN ABUNDANT LIFE BAPTIST CHURCH OUTING

__________________________________________________ Age: _________ Enrolled in Grade: _________

(Full Name of Student)

Address: ____________________________________________________ Home Phone No.: __________________________

(Street, City, State, Zip Code)

Medical Insurance Company: _________________________________ Policy Number/Group Number: __________________

Identification Number: ______________________________________

Family Physician: __________________________________________________ Phone No.: ___________________________

Allergies: ______________________________________________________________________________________________

Medications Being Taken or Prescribed/Possible Side Effects: ____________________________________________________

Other Special Medical Conditions or Allergies to Medications: ____________________________________________________

Other Special Instructions: _________________________________________________________________________________

Alternative Individuals and Emergency Phone Numbers in the Event You Cannot be Reached:

1. ________________________________________________________ Phone No. ___________________________________

(Name)

2. _________________________________________________________Phone No. ___________________________________

(Name)

I/We, give my/our permission for the above named student to participate in the ALBC Outing to _________________________

____________________________________________. By signing this consent form the student also indicates that s/he

understands this permission form.

I/We, give my/our consent for my/our child to receive medical treatment in the event of injury or illness while

participating in the above activity. As indicated above we/I further grant to the alternative individual designated

above the same rights, powers and authority to make decisions concerning medical care for the child as I/we would

be able to do.

I/We, certify, that I/we (have) (do not have) hospital, health or medical insurance as indicated above. I/We further

agree to permit said insurance to be used in case of any injury or illness.

Student's Signature: _______________________________________________ Date __________________________________

Parent's/Guardian's Name: ________________________________________________________________________________

(Signature)

Employer: _______________________________________________________ Work Phone No.: ________________________

Parent's/Guardian's Name: ______________________________________________________________________ __________

(Signature)

Employer: _______________________________________________________ Work Phone No.: ________________________

Note: If you are a single parent or for any reason difficult to reach, please include above, in addition to your own

home, work, mobile phone or pager number, the number for another person who you would designate as responsible to act on your behalf in the event you cannot be reached.