Adventure Club Consent and Release Form


I, the undersigned parent or guardian, hereby consent to my child participating in Adventure Club sponsored by Kootenai Community Church on Friday nights from 6:30 p.m. to 8:15 p.m.  I certify that my child is able to participate in these activities including games, snacks, and Bible lessons.  If my child has a medical condition I have listed it below.  In the event that an emergency occurs, I may be reached at the telephone number given on the registration side of this form.  If I cannot be reached, I hereby authorize an adult leader to make emergency medical decisions for my child.  If there are any activities I do not want my child to be involved in, I have listed them below.

I UNDERSTAND AND HEREBY AGREE TO ASSUME ALL THE RISKS WHICH MAY BE ENCOUNTERED ON SAID ACTIVITY, INCLUDING ACTIVITIES PRELIMINARY AND SUBSEQUENT THERETO.  I do hereby agree to hold Kootenai Community Church and their agents and employees, harmless from any and all liability, actions, causes of actions, claims, expenses, and damages on account of injury or illness to my child or property, even injury or illness resulting in death, which I now have or which may arise in the future in connection with the activity or participation in any other associated activities.

I expressly agree that this release, waiver, and indemnity agreement is intended to be as broad and inclusive as permitted by the State of Idaho and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.  This release contains the entire agreement between the parties hereto and the terms of this release are contractual and not mere recital.

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 that I have read and understand.

Please list the name of your child(ren) that you are registering. If more than one, please list names separated by a comma:
 

Food allergies, other allergies, or restrictions in game participation:
 

Medical conditions of which to be aware:
 

I do not wish my child to participate in the following:
 

Leave this empty:

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Signature Certificate
Document name: Adventure Club Consent and Release Form
lock iconUnique Document ID: e60646b8aa5725aaae3d7a136091a98b3fa62794
Timestamp Audit
August 18, 2021 1:16 pm PDTAdventure Club Consent and Release Form Uploaded by Joshua Comstock - media@kootenaichurch.org IP 216.244.82.210
August 18, 2021 1:43 pm PDTDiane Rich - dianeErich@gmail.com added by Joshua Comstock - media@kootenaichurch.org as a CC'd Recipient Ip: 69.59.65.173
August 18, 2021 1:45 pm PDTDiane Rich - dianeErich@gmail.com added by Joshua Comstock - media@kootenaichurch.org as a CC'd Recipient Ip: 69.59.65.173
August 18, 2021 1:46 pm PDTDiane Rich - dianeErich@gmail.com added by Joshua Comstock - media@kootenaichurch.org as a CC'd Recipient Ip: 69.59.65.173
August 18, 2021 1:57 pm PDTDiane Rich - dianeErich@gmail.com added by Joshua Comstock - media@kootenaichurch.org as a CC'd Recipient Ip: 216.244.82.210
August 18, 2021 1:59 pm PDTDiane Rich - dianeErich@gmail.com added by Joshua Comstock - media@kootenaichurch.org as a CC'd Recipient Ip: 216.244.82.210
August 18, 2021 2:00 pm PDTDiane Rich - dianeErich@gmail.com added by Joshua Comstock - media@kootenaichurch.org as a CC'd Recipient Ip: 216.244.82.210
August 18, 2021 2:01 pm PDTDiane Rich - dianeErich@gmail.com added by Joshua Comstock - media@kootenaichurch.org as a CC'd Recipient Ip: 216.244.82.210
August 18, 2021 2:25 pm PDTDiane Rich - dianeErich@gmail.com added by Joshua Comstock - media@kootenaichurch.org as a CC'd Recipient Ip: 216.244.82.210
August 18, 2021 2:26 pm PDTDiane Rich - dianeErich@gmail.com added by Joshua Comstock - media@kootenaichurch.org as a CC'd Recipient Ip: 216.244.82.210
August 18, 2021 4:03 pm PDTJosh Comstock - josh@josharlahld.com added by Joshua Comstock - media@kootenaichurch.org as a CC'd Recipient Ip: 216.244.82.210
August 18, 2021 4:14 pm PDTDiane Rich - dianeErich@gmail.com added by Joshua Comstock - media@kootenaichurch.org as a CC'd Recipient Ip: 216.244.82.210
August 18, 2021 4:16 pm PDTDiane Rich - dianeErich@gmail.com added by Joshua Comstock - media@kootenaichurch.org as a CC'd Recipient Ip: 216.244.82.210
August 18, 2021 4:16 pm PDTMarcia Whetsel - secretary@nctv.com added by Joshua Comstock - media@kootenaichurch.org as a CC'd Recipient Ip: 216.244.82.210
August 18, 2021 4:16 pm PDTKathy Conger - secretary@kootenaichurch.org added by Joshua Comstock - media@kootenaichurch.org as a CC'd Recipient Ip: 216.244.82.210