East Bergen Christian Church (EBCC)

320 Beverly Road, Teaneck, NJ 07666

Liability Release Form – Release of All claims

            In consideration for being accepted by East Bergen Christian Church (EBCC) for attending the “(name of program/class)”, I, being the parent and on behalf of my child, do hereby release, forever discharge and agree to hold harmless (EBCC) and the directors thereof from any/all liabilities, claims or demands for personal injury, harassment, sickness or death, as well as property damage and expenses of any nature whatsoever which may be incurred by the undersigned and the child participant that occur while said child is participating in the above (class/program).

I hereby assume all risk or personal injury, harassment, sickness, death, damage and expenses as a result of participating in the above class.

            I hereby agree to hold harmless and indemnify EBCC, its directors, employees and agents, for any liability sustained by EBCC as a result of the negligent, willful or intentional acts of said participant, including expenses incurred thereto.     

            Further, should it be necessary for my child to return home due to medical reasons or disciplinary action, I assume all transportation costs.

Child Name:  ________________________

Parent Name: _______________________

Emergency Phone: ___________________

Hospital Insurance:             (  ) Yes                                    (   ) No

Signature: ______________________                      Date: __________________