United Summer Vibe Bubble Ball

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United

Consent and Release of Liability for Minors


(PLEASE PRINT)

I, the undersigned parent or guardian, hereby consent to my child, ________________________________ who is


____ years of age, participating in the activities connected with United Service at Grace Family Church Van Dyke
Campus, on June 22nd, 2018, from approximately 6:00pm to 9:00pm. I certify that my child is able to participate in
these activities, including but not limited to playing with children outdoors and indoors, sports activities, and
involvement in Bubble Ball (participants get into a large plastic ball, run into other students also in plastic balls and
bounce off objects while competing in challenges). If my child has medical conditions which may be relevant to a
physician in the event of an emergency, I have listed them on the back of this page. If I cannot be reached within a
reasonable period of time, I hereby authorize the adult sponsor, the Youth Director, or the Grace Family Team
Leader, to make emergency medical decisions for my child. If there are activities in which I do not want my child
to participate, I have listed them on the back of this page.

READ THIS FORM COMPLETELY AND CAREFULLY. YOU ARE AGREEING TO LET YOUR MINOR CHILD
ENGAGE IN A POTENTIALLY DANGEROUS ACTIVITY. YOU ARE AGREEING THAT, EVEN IF GRACE
FAMILY CHURCH AND ITS EMPLOYEES AND VOLUNTEERS USE REASONABLE CARE IN PROVIDING
THIS ACTIVITY, THERE IS A CHANCE YOUR CHILD MAY BE SERIOUSLY INJURED OR KILLED IN
PARTICIPATING IN THIS ACTIVITY BECAUSE THERE ARE CERTAIN DANGERS INHERENT IN THE
ACTIVITY WHICH CANNOT BE AVOIDED OR ELIMINATED. BY SIGNING THIS FORM YOU ARE GIVING
UP YOUR CHILD’S RIGHT AND YOUR RIGHT TO RECOVER FROM GRACE FAMILY CHURCH OR ANY OF
ITS EMPLOYEES, AGENTS, OR VOLUNTEERS IN A LAWSUIT FOR ANY PERSONAL INJURY, INCLUDING
DEATH, TO YOUR CHILD OR ANY PROPERTY DAMAGE THAT RESULTS FROM THE RISKS THAT ARE A
NATURAL PART OF THE ACTIVITY. YOU HAVE THE RIGHT TO REFUSE TO SIGN THIS FORM, AND
GRACE FAMILY CHURCH HAS THE RIGHT TO REFUSE TO LET YOUR CHILD PARTICIPATE IF YOU DO
NOT SIGN THIS FORM.

I further state that I HAVE CAREFULLY READ THE FOREGOING RELEASE AND KNOW THE CONTENTS
THEREOF, AND I SIGN THIS RELEASE AS MY OWN FREE ACT. This is a legally binding agreement, which I
have read and understand.

I DO NOT Wish My Child to participate in the Following Activities: ___________________________________

_______________________________________ __________________________________________________
Parent or Guardian Signature Parent or Guardian / Please Print

Date: __________________________________ Date: _____________________________________________

MEC 061118

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