LIABILITY ACKNOWLEDGEMENT AND PERMISSION FORM (MINORS) I, , being the ,(parent or authorized guardian) of , a child under eighteen years of age, do hereby give my consent and permission for him/her to participate in the activities at the AGAPE COMMUNITY CENTER located at 342 West 111th Street, Chicago, Illinois. ACKNOWLEDGEMENT I hereby understand and acknowledge that this is an activity that incorporates discipline and supervision during participation. I additionally understand and acknowledge that the instructors are mature and intelligent, and will use wisdom and caution to minimize the possibility of accidental injury. However, because of the type of activity involved, I also understand and acknowledge that the prospect of bodily injury while participating in the activities at the Agape Community Center is a possibility even under the most stringent and safest conditions. WAIVER Having understood and acknowledge the above, I hereby release, forever discharge and agree to hold harmless the Agape Community Center, Cru®, which it is a part of, its directors, employees, and volunteers, from any and all liability, claims, or demands for personal injury, sickness, or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by the undersigned and the above named child that occur during activities with the Agape Community Center. Furthermore, I hereby assume all risk of personal injury, sickness, death, damage, and expense as a result of participation in these activities. The undersigned further agrees to hold harmless and indemnify the above mentioned Agape Community Center, its directors, employees, or volunteers, for any liability sustained by said community center as the result of the negligent, willful, or intentional acts of the above named child, including expenses incurred attendant thereto. Parent’s/Guardian’s Signature Date Please check the boxes if you give permission for the following: I give my permission to the Center staff member who works with my child to talk with my child’s teacher about my child’s schoolwork and special needs. I give my permission for my child’s picture to be taken while at the Center knowing that it might be used in ministry materials, such as newsletters or brochures. I give my permission for my to be transported by Agape approved workers in vehicles and/or the worker’s personal vehicle.
LIABILITY ACKNOWLEDGEMENT AND PERMISSION FORM (MINORS) I, , being the ,(parent or authorized guardian) of , a child under eighteen years of age, do hereby give my consent and permission for him/her to participate in the activities at the AGAPE COMMUNITY CENTER located at 342 West 111th Street, Chicago, Illinois. ACKNOWLEDGEMENT I hereby understand and acknowledge that this is an activity that incorporates discipline and supervision during participation. I additionally understand and acknowledge that the instructors are mature and intelligent, and will use wisdom and caution to minimize the possibility of accidental injury. However, because of the type of activity involved, I also understand and acknowledge that the prospect of bodily injury while participating in the activities at the Agape Community Center is a possibility even under the most stringent and safest conditions. WAIVER Having understood and acknowledge the above, I hereby release, forever discharge and agree to hold harmless the Agape Community Center, Cru®, which it is a part of, its directors, employees, and volunteers, from any and all liability, claims, or demands for personal injury, sickness, or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by the undersigned and the above named child that occur during activities with the Agape Community Center. Furthermore, I hereby assume all risk of personal injury, sickness, death, damage, and expense as a result of participation in these activities. The undersigned further agrees to hold harmless and indemnify the above mentioned Agape Community Center, its directors, employees, or volunteers, for any liability sustained by said community center as the result of the negligent, willful, or intentional acts of the above named child, including expenses incurred attendant thereto. Parent’s/Guardian’s Signature Date Please check the boxes if you give permission for the following: I give my permission to the Center staff member who works with my child to talk with my child’s teacher about my child’s schoolwork and special needs. I give my permission for my child’s picture to be taken while at the Center knowing that it might be used in ministry materials, such as newsletters or brochures. I give my permission for my to be transported by Agape approved workers in vehicles and/or the worker’s personal vehicle.
R2-Registration-Form-for-Minors-1-W.docx