Cornerstone Chapel

Participant Release of Liability and Assumption of Risk Agreement


Name(s) of Participant(s)

(You must be the parent/legal guardian of the children listed on this form.)

Participant 1:    
Participant 2:  
Participant 3:  
Participant 4:  
Participant 5:  

Event Name: Vacation Bible School 2021

In consideration of participating in this program’s related events and activities, I, the undersigned, acknowledge and agree that:

  1. The risk of injury from the activities involved in this program is significant, including the potential for permanent paralysis and death and I knowingly and willingly assume all such risks, both known and unknown, and assume responsibility for my participation.
  2. I willingly agree to the terms and conditions for participation, on or off premises, and will remove myself from participation if I observe any unusual, significant hazard.
  3. I know my personal health and physical limitations and will remove myself from an activity if I feel participation would be detrimental to my emotional or physical health; and will accept responsibility for participating without regard to my known or unknown limitations.
  4. By participating in or attending any activity in connection with this program, I consent to the use of any and all photographic images and video or audio recordings taken of me or provided by me for promotional, website, or other related marketing materials or use, and waive any right of privacy, compensation, copyright or other ownership right connected to the same.
  5. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, do release, acquit, discharge, and covenant to hold harmless and indemnify Cornerstone Chapel, its representatives, their volunteers, activity leaders and assigns from any and all injuries, disabilities, actions, damages to persons or properties, and liabilities arising out of any incident, accident or sickness, or treatment thereof, incurred by my participation in this program and/or activities, to the fullest extent permitted by law. This would include activities in the building, activities on the property and activities off-site. In the event of emergency where I am unable to give consent, and my emergency contact is unable to be reached, I hereby authorize an adult leader of this activity, as agent for me, to consent to any medical or dental treatment and care deemed necessary by medical personnel.
  6. In the event of any dispute or disagreement between parties listed with respect to this agreement, each party shall appoint a representative whose task it will be to meet with the representative appointed by the other party for the purpose to resolve any dispute. No legal action regarding the dispute may take place until either one of the two representatives concludes in good faith that a resolution does not appear likely. At that time the dispute shall be settled only by mediation and, if necessary, legally binding arbitration in accordance with the Rules of Procedure for Christian Conciliation of the Institute for Christian Conciliation, (complete text of the Rules is available at www.ICCPeace.com). In that case, Judgment upon an arbitration award may be entered by any court having competent jurisdiction, in conformity with the laws of the Commonwealth of Virginia.
  7. I understand and acknowledge that, under the Uniform Electronic Transactions Act, by proceeding to register online and by signing this waiver electronically, such electronic registration and electronically signed Waiver will be valid and enforceable in the same manner as a hand-signed document that exists in physical form and that a record or signature may not be denied legal effect or enforceability under law solely because it is in electronic form.

I have read this release of liability and assumption of risk agreement and fully understand and agree to its terms as indicated by my signature below.

For parents/guardians of minor age participants (under 18 at time of registration):
I, as parent or guardian for minor participant, do release, acquit, discharge, and covenant to hold harmless and indemnify Cornerstone Chapel, its representatives, their volunteers, activity leaders and assigns from any and all injuries, disabilities, actions, damages to persons or properties, and liabilities arising out of any incident, accident or sickness, or treatment thereof, incurred by my minor child’s participation in this program and/or activities, to the fullest extent permitted by law.

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Signature Certificate
Document name: Participant Release of Liability and Assumption of Risk Agreement
lock iconUnique Document ID: f264ffbbafc2c4608db1e9f90afa244abdadffbb
Timestamp Audit
February 27, 2020 3:36 pm EDTParticipant Release of Liability and Assumption of Risk Agreement Uploaded by Cornerstone Chapel - edocs@cornerstonechapel.net IP 174.196.134.196
February 27, 2020 3:40 pm EDTChildren's Ministry - vbs@cornerstonechapel.net added by Cornerstone Chapel - edocs@cornerstonechapel.net as a CC'd Recipient Ip: 174.196.149.87
February 28, 2020 3:44 pm EDTChildren's Ministry - vbs.volunteers@cornerstonechapel.net added by Cornerstone Chapel - edocs@cornerstonechapel.net as a CC'd Recipient Ip: 174.196.137.158
March 5, 2020 1:24 pm EDTChildren's Ministry - vbs.volunteers@cornerstonechapel.net added by Cornerstone Chapel - edocs@cornerstonechapel.net as a CC'd Recipient Ip: 50.225.112.66
March 5, 2020 1:25 pm EDTChildren's Ministry - vbs.volunteers@cornerstonechapel.net added by Cornerstone Chapel - edocs@cornerstonechapel.net as a CC'd Recipient Ip: 174.196.151.176
May 27, 2020 1:22 pm EDTChildren's Ministry - vbs.volunteers@cornerstonechapel.net added by Cornerstone Chapel - edocs@cornerstonechapel.net as a CC'd Recipient Ip: 174.196.135.55
March 4, 2021 3:01 pm EDTChildren's Ministry - vbs.volunteers@cornerstonechapel.net added by Cornerstone Chapel - edocs@cornerstonechapel.net as a CC'd Recipient Ip: 50.225.112.66