ACTIVITY INFORMATION (To be completed by the activity sponsor) Sponsoring ministry(ies): Ministry Leader:______________________________________________Telephone: Name of activity coordinator:____________________________________Telephone: Description of activity:

Date(s) and location(s) of activity:

PARTICIPANT INFORMATION (To be completed by participant or an authorized guardian) Name of participant: Address:____________________________________________________ Telephone: Name of emergency contact: Telephone:
(Day) (Alternate)

Is sponsor authorized to approve medical treatment? Yes Has participant completed a Medical Consent Form? Yes If no, this must be completed prior to participating in this activity. PARTICIPATION AGREEMENT

No No

By signing below, the participant (or parent/guardian if participant is a minor) acknowledges and accepts the risks of physical injury associated with participation in the activity described above. The participant (or parent/guardian) accepts personal financial responsibility for any bodily or personal injury sustained during the activity. Further, the participant (or parent/guardian) promises to hold harmless the New Life Community Church and its representatives for any injury or illness related to the activity. If a dispute over this agreement or any claim for damages arises, the participant (or parent/guardian) agrees to resolve the matter through a mutually acceptable arbitration process.


(Participant or parent/guardian if participant is a minor)


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