Liability Release Form

Release of All Claims

In consideration for being accepted by Impact Christian Church of Moon Township, PA for participation in activities sponsored or attended on or between January 1, 2019 to December 31, 2019, we do hereby release, forever discharge and agree to hold harmless Impact 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 trips or activities noted above.

Furthermore, we hereby assume all risk of personal injury, sickness, death, damage and expenses as a result of participation in recreation and work activities involved therein.

Furthermore, authorization and permission is hereby given to said church to furnish any necessary transportation, food and lodging for this participant.

The undersigned further hereby agree to hold harmless and indemnify said church, its directors, employees and agents, for any liability sustained by such church as the result of negligent, willful, or intentional acts of said participant, including expenses incurred attendant thereto.

We are the parents or legal guardians of this participant, and hereby grant our permission for him/her to participate fully in any activity, and hereby give our 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 reason, disciplinary action or otherwise, we hereby assume all transportation costs.

Finally, my signature authorizes Impact Christian church to take photos of my child(ren) to be used for promotion in Impact Kids private social media groups

Liability Release Form
Event Title

Submission of this form will be applicable for all events during the calendar year.

Participant #1

Participant #2

Participant #3

Participant/s Address


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Emergency Contacts

Electronic Signature
Agree to release all claims*

I attest that I am the legal guardian and can legally sign for the stated minor.

Photo Permissions
I give permission for Impact Christian Church to take photos of my child(ren) to be used for public promotion.

I attest that I am the legal guardian and can legally sign for the stated minor.