Norwin Christian Youth Release Form
Church Activities for 2022
Name of Minor
First Name
Last Name
Parent/Guardian Contact Information
First Name
Last Name
Home Phone
Cell Phone
Email
example@example.com
As a parent/legal guardian of above minor youth, I have reviewed the information about this event, and give permission for the above minor youth to be involved in the overall activities.
I/We also acknowledge that if the subject of the release has to return home early for discipline violations, it will be at my/our expense.
I/We understand all reasonable safety precautions will be taken at all times by Norwin Christian Church and its agents during the events and activities.
I/We do hereby release, forever discharge and agree to hold harmless Norwin Christian Church, and the directors/ pastors/ volunteers thereof, from any and all liability, claims, or demands for personal injury, sickness or death, as well as property damages and expenses.
This release covers transportation provided by Norwin Christian Church and its representatives who are properly licensed to drive in the state of Pennsylvania: And meetings on any other site during programs, and activities: And refreshments, purchased or homemade that will be served at above programs: And consent for emergency medical or dental treatment, including examination, diagnosis, treatment, anesthetic, and surgical treatment, the undersigned agrees to pay for all costs
and expenses.
Please keep this Release Form on file for 2022
Yes
I have read and understand the above information
Parent/Guardian Name
First Name
Last Name
Date
-
Month
-
Day
Year
Date
Parent/Guardian Signature
Submit
Should be Empty: