Cornerstone Chapel

VBS - Waiver of Liability


Name(s) of Participants

Child 1:  
Child 2:  
Child 3:  
Child 4:  
Child 5:  

  • I agree to provide truthful information on my registration form.
  • I give my permission for my child to participate in all activities of Cornerstone Chapel VBS 2021.
  • As parent or legal guardian, I acknowledge the following responsibilities: I will take my child to their Team Leader/Assistant each morning. I will check in my child by 9:00am and sign out my child at 12:00pm, with their Team Leader/Assistant each VBS day. I will be available at all times at the given phone numbers in case of an emergency.
  • I, myself, or the undersigned parent and/or guardian of said youth, give permission for said youth to participate in all of Cornerstone Chapel’s VBS activities. This would include activities in the building and activities on the property. I am confident that the adult leaders and sponsors will take appropriate care of my child and every effort will be made for his/her safety. However, I understand that accidents do occur, and in the event of an emergency, every effort will be made to contact me. In the event of an emergency, 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. I also agree to pay for the medical treatment whether through my own medical insurance coverage or my own financial obligation.
  • I, myself, or the undersigned parent and/or guardian of said youth, do release, acquit, discharge, and covenant to hold harmless and indemnify Cornerstone Chapel, its representatives, its volunteers and its activity leaders from any and all actions, damages, and liabilities arising out of any accident or sickness, or treatment thereof, incurred by said youth during the minor’s participation in Cornerstone Chapel programs or activities.
  • I give permission for my son/daughter to appear in photographs and videos for future promotions.
  • If at any time I provide an email or text address to Cornerstone Chapel at which I may be contacted, I consent to receiving communications/information at that email or text address. Cornerstone Chapel does not charge for this service, but standard text messaging rates may apply as provided in your wireless plan (contact your carrier for pricing plans and details).
  • 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.
  • 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 the above information and by signing here I give my authorization.

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Signature Certificate
Document name: VBS - Waiver of Liability
lock iconUnique Document ID: 2b0368a751be13f2214d145b78fe94b761a136c6
Timestamp Audit
February 27, 2020 4:26 pm ESTVBS - Waiver of Liability Uploaded by Cornerstone Chapel - edocs@cornerstonechapel.net IP 50.225.112.66
February 27, 2020 4:29 pm ESTChildren'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 4:40 pm ESTChildren's Ministry - vbs@cornerstonechapel.net added by Cornerstone Chapel - edocs@cornerstonechapel.net as a CC'd Recipient Ip: 174.196.139.17
March 4, 2021 3:20 pm ESTChildren's Ministry - vbs@cornerstonechapel.net added by Cornerstone Chapel - edocs@cornerstonechapel.net as a CC'd Recipient Ip: 50.225.112.66
March 4, 2021 3:39 pm ESTChildren's Ministry - vbs@cornerstonechapel.net added by Cornerstone Chapel - edocs@cornerstonechapel.net as a CC'd Recipient Ip: 50.225.112.66