RCY Medical/Liability Release Form

RCY Medical/Liability Release Form

Waiver of Liability and Assumption of Risk Agreement
PARENT / GUARDIAN AUTHORIZATION

As a parent/guardian, I understand that my son/daughter will be under the supervision of the adult sponsors of River City Church. I give my full permission for him/he to attend River City Church and activities at 7950 Belfort Parkway, Jacksonville, FL 32256. Every gathering, event, and trip of River City is carefully planned and adequately supervised by mature adults. However, even with the best of planning and precaution, unforeseen events can occur. By signing this form, the parent or guardian agrees to assume and accept all risks and hazards inherent in River City Church's gatherings, events, and trips. They also agree not to hold River City Church, its employees, or volunteers liable for damages, losses, or injuries to the person or property undersigned.
Name of Student

First NameLast Name
Date of Birth

MonthDayYear
Date
Gender
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact

First NameLast Name
Emergency Contact Phone Number

Area CodePhone Number
Insurance Company Information
Medical Notes:
Enter notes about your medical condition, allergies, prescriptions, or dietary restrictions here
Event Name:
ELECTRONIC SIGNATURE AUTHORIZATION

By applying my electronic signature to this agreement, I agree that my electronic signature is the legally binding equivalent of my handwritten signature on paper. I will not, at any future time, claim that my electronic signature is not legally binding or enforceable.

By electronically signing and submitting this agreement, I 1) acknowledge that I have read and fully understand the terms of the agreement; 2) voluntarily agree to be bound by this agreement; and 3) certify that I am 18 years of age or older. My signature applies to all pages of this contract. I understand that I will receive a Portable Document Format (PDF) version of this agreement after it is signed at the email address I have provided. To view the PDF document, I understand that I will need software that enables me to receive and access PDF files such as Adobe Reader software or other software capable of reading a PDF file. In order to print and retain a hard copy of this agreement, I understand that I will also need a printer connected to my computer. I understand that if I wish to sign a hard copy of this agreement instead of an electronic version, I must contact the party that requires my signature on this agreement directly.
Name of Parent / Guardian for Waiver

First NameLast Name
Date

MonthDayYear
Date
Signature
Should be Empty: