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Adult Attendee First Name

Adult Attendee Last Name

List First and Last Names and Ages of other adult family members who are participating (age 18 or older)

List First and Last Names and Ages of other family members participating (under the age of 18)
(The signed parent or guardian takes full responsibility for those listed here, even if the parent or guardian will not be in attendance at the event)

Your Address

Street

City

State

Zip Code

Email Address

Phone Number

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Choose a time slot 8:30-10:0010:00-11:30

Waiver of Liability

*BEFORE SIGNING READ CAREFULLY BEFORE SIGNING; YOU GIVE UP CERTAIN RIGHTS BY SIGNING THIS DOCUMENT.

I, UNDERSTAND THAT ALL RECREATIONAL AND ADVENTURE ACTIVITIES WHICH ARE PART OF THIS FAMILY EVENT MAY INVOLVE SOME RISK OF INJURY OR DEATH FROM VARIOUS HAZARDS, BOTH OBVIOUS AND OBSCURE, INCLUDING BUT NOT LIMITED TO, INJURY BY ACTS OF OTHER GROUP PARTICIPANTS, FALLING, BEING STRUCK BY FALLING OBJECTS, EQUIPMENT FAILURE AND OTHER RISKS OR OCCURRENCES NOT SET FORTH IN THIS AGREEMENT.

BY PRINTING MY SIGNATURE ON THIS DOCUMENT, I ACCEPT AND ASSUME RESPONSIBILITY FOR EACH PERSON LISTED ON THIS FORM FOR ANY AND ALL SUCH RISKS WHETHER OR NOT SPECIFICALLY ITEMIZED HEREIN AND ACKNOWLEDGE THAT THE GATE CHURCH , ITS EMPLOYEES, ASSOCIATES, CORPORATE OFFICERS, BOARD MEMBERS, PROPERTY OWNERS, FAMILY OF THE SAME AND ANY ORGANIZATION THAT THE GATE REPRESENTS OR CONTRACTS WITH SHALL BE HELD HARMLESS AND BLAMELESS IN THE EVENT OF SUCH AN AFOREMENTIONED MISHAP. I KNOW AND AM PREPARED FOR THE AFOREMENTIONED RISKS AND WILL NOT LOOK TO ANY ENTITY OR INDIVIDUAL NOR HOLD THEM RESPONSIBLE FOR THE WELL BEING OR THE PROTECTION FROM SUCH RISKS OF ANYONE NAMED ON THIS FORM, WHETHER OR NOT THOSE RISKS ARE KNOWN OR UNKNOWN BY THOSE ORGANIZATIONS OR INDIVIDUALS.

IN CONSIDERATION FOR PARTICIPATING IN ANY AND ALL ACTIVITIES WITH THE GATE CHURCH I DO HEREBY IRREVOCABLY RELEASE THE GATE CHURCH, ITS EMPLOYEES, ASSOCIATES, CORPORATE OFFICERS, BOARD MEMBERS, PROPERTY OWNERS, FAMILY OF THE SAME AND ANY ORGANIZATION THAT THE GATE CHURCH REPRESENTS OR CONTRACTS WITH, THEIR SUCCESSORS AND ASSIGNS FROM ANY AND ALL CLAIMS WHICH INVOLVE ANY NATURE OF INJURY OR DEATH OR DAMAGE TO PERSONS OR PROPERTY THAT MAY OCCUR AS A RESULT OF ATTENDANCE OR PARTICIPATION IN SUCH AFOREMENTIONED ACTIVITIES BY ANYONE LISTED ON THIS FORM.

PHOTOS, VIDEOS, ETC: BY SIGNING THIS I GIVE MY PERMISSION TO THE GATE CHURCH AND PHOTOGRAPHERS OR VIDEOGRAPHERS ASSIGNED BY THE GATE CHURCH TO USE ANY PHOTOS OR VIDEO FOOTAGE WHICH INCLUDES MY SELF OR OTHER FAMILY MEMBERS LISTED ON THIS FORM FOR ONLINE OR PROMOTIONAL PURPOSES. I ALSO GIVE PERMISSION TO USE ANY WRITTEN QUOTES FOR PROMOTIONAL PURPOSES.

Parent's Signature (First & Last Name of Attendee, Parent or Guardian)