J.A.M. - Junior Active Ministry
Registration & Liability Release Form
Worthington United Methodist Church
In consideration for being accepted by Worthington United Methodist Church for participation in the trips, retreats and all other activities planned by the church, do for and on the behalf of my child participant do, hereby release, forever discharge and agree to hold harmless Worthington United Methodist Church and the directors thereof from any and all liability, claims or damages for personal injury, sickness or death, as well as property damage and expenses, of any nature whatsoever which may incurred by __________________________________ while said youth is participating in all church sponsored activities.
Furthermore, we (I) on the behalf of our (my) child participant hereby assume all risk of personal injury, sickness, death, damage and expenses as a result of participation in recreation and work activities involved therein.
Further 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 said church as a result of the negligent, willful or intentional acts of said participant, including expenses incurred attendant thereto.
Name of Child:
Parent/Guardian Signature:
BirthDate:
Today's Date:
Phone Number:
Cell Phone Number:
Email Address:
Address: