Liability form

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In consideration for being accepted by River of Life Christian Church for participation in any church event or
otherwise occurring from Januaray 01, 2005 and any date thereafter, we (I) being twenty-one (21) years of age or older,
do for ourselves (myself) [and for and on behalf of my child-participant if said child is not twenty-one (21) years of age
or older] do hereby release, forever discharge and agree to hold River of Life Christian Church and the directors thereof
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 child-participant that occur
while said child is participating in the above-described trip or activity, or any trip or activity.
Furthermore, we (I) [and on behalf of our (my) child-participant if under the age of twenty-one (21) years]
hereby assume all risk of personal injury, sickness, death, damage and expense as a result of participation in any and
all events, meetings, recreation and work activities involved therein.
Further, authorization and permission is hereby given to said church to furnish any necessary transportation,
food and lodging for this participant. This release covers transportation provided by ROLCC and their representatives
who are properly licensed to drive in the state of California that will be driving the minors to ROLCC or any other site
during program and activities.

The undersigned further hereby agree to hold harmless and indemnify said church, its directors, employees
and agents, for any liability sustained by said church as the result of the negligent, willful or intentional acts of said
participant, including expenses incurred attendant thereto.
(If the participant has not attained the age of 21 years):
We (I) are the parent(s) or legal guardian(s) of this participant, and hereby grant our (my) permission for him
(her) to participate fully in said trip, and hereby give our (my) permission to take said participant to a doctor or hospital
and hereby authorize medical treatment, including but not in limitation to emergency surgery or medical treatment, and
assume the responsibility of all medical bills, if any.
Further, should it be necessary for the participant to return home due to medical reasons, disciplinary action or
otherwise, we (I) hereby assume all transportation costs.
____________________________________ ____________________________________
(Type or print name of participant)                    [Parent(s) telephone]

Hospital Insurance: ____Yes ____No
Insurance Company: _______________________________ Policy Number: _____________________
Physician's Phone Number: _________________________
Emergency Phone Numbers: ________________________ ____________________________________
(Regardless of age, both parents along with participant must sign unless parents are separated or divorced in which case the custodial parent must
sign.)
____________________________________ _________________________________________
Father's Signature                        Date         Mother's Signature                              Date
____________________________________ _________________________________________
Legal Guardian's Signature           Date         Participant's Signature                         Date

Participant Only
I have read the foregoing and understand the rules of conduct for participants and will abide by them as well as
the directors of the leadership of the trip, event, or activity.
____________________________________
Participant


LiabilityForm1.pdf