Participation Waiver 
Child(rens) Information

Name(s): *


Parent Info

Name *

Cell Phone number *

Please read this form carefully and be aware that in registering your minor child/ward for participation in Parkview Community Church Christmas Breakfast you will be waiving and releasing all claims for injuries you or your child/ward might sustain arising out of these programs. This form must be signed by the parent or guardian.

Waiver, Release, Indemnify, Hold Harmless and Permission to Secure Treatment Agreement   Parkview Community Church is committed to conducting its events and programs in the safest manner possible and hold the safety of its participants in the highest possible regard. Parents/guardians registering their child/ward for an event or program must recognize, however, that there is an inherent risk of injury when choosing to participate in student ministry events and programs. Parkview Community Church continually strives to reduce such risks and insist that all participants follow safety rules and instructions, which have been designed to protect the participants’ safety.   Parents/Guardians registering their child/ward for the Parkview Community Church events should review their own health insurance policy for coverage. It must be noted that the absence of health insurance does not make Parkview Community Church responsible for payments of medical expenses. Due to the difficulty and high cost of obtaining liability insurance, the agency providing liability coverage for Parkview Community Church REQUIRES the execution of the following Waiver and Release. Your cooperation is greatly appreciated.   Waiver and Release of ALL Claims   As a participant in the Parkview Community Church student ministry events I agree to assume the full risk of any injuries, including death, damages or loss regardless of severity, which my child/ward may sustain as a result of participating in any and all activities connected with or associated with such an event.   I agree to waive and relinquish all claims my child/ward may have as a result of participating in ministry events against Parkview Community Church and its directors, officers, trustees, and employees.   I do hereby release and discharge Parkview Community Church and their respective directors, officers, trustees, and employees from any claims from injuries, including death, damage or loss which may have occurred on account of my child/ward.   I further agree to indemnify and hold harmless and defend Parkview Community Church and their respective directors, officers, trustees, and employees from any claims from injuries, including death, damages, or losses sustained by my child/ward or arising out of, connected with, or in any way associated with the activities of the program.   Permission to Secure Treatment   In the event of an emergency, I authorize Parkview Community Church officials/or employees to secure treatment from any licensed hospital, physician, and/or medical personnel, and/or any treatment deemed necessary for my child’s/ward’s immediate care. I agree that I will be responsible for payment of any and all medical services required.   Photographs and Audio/Digital Recordings.   Student, Parent(s)/Guardian(s) grant Parkview Community Church the right to take photographs and audio/digital recordings of the student while participating in any activities during the event and authorizes Parkview Community Church, its agents, employees, and volunteers, to copyright, use and publish the photographs in print or electronically. The undersigned further agree that Parkview Community Church may use such photographs for any lawful purpose including publicity, illustration, advertising, and website content and waive any right of compensation or ownership thereto. Your child’s name or any other personal information will not be disclosed with the photograph.

I have read and fully understand the aforementioned program details, waiver and release of all claims and permission to secure treatment, and all information supplied by me is accurate and current to the best of my knowledge. *

Typing my name serves as my digital signature.