Adult Release Form

Adult Ministry Release Form

Event Name *
Event Date *
Participation Information
Name * Title First Middle Last Suffix
Address *
Street Address Address Line 2 City State / Province Postal / Zip Code Country
Gender *
Male Female
Age
Emergency Information
Emergency Contact Name *
Relationship
Phone * ### - ### - ####
Work/Cell Phone ### - ### - ####
If a situation arises, I grant consent to the director of this event to arrange for emergency first-aid and medical equipment.
Participants' Signature *

(Must be 21 years of older)
Adult Liability Release of All Claims
Event Name
Event Date:
In participating with a Trinity Lutheran Church sponsored event, I, being 21 years-of-age or older, do release, further discharge and agree to hold harmless Trinity Lutheran Church, Stillwater, MN and the directors from any and all liability, claims or demands for personal injury, sickness, death, damage and expense as a result of participation in recreation and work activities involved in this event. I, the undersigned, further agree to hold harmless and indemnify Trinity Lutheran Church, its directors, employees and agents, for any liability sustained by the church as the result of the negligent, willful or intentional acts of myself as a participant, including expenses incurred. I grant my permission to be taken to a doctor or hospital and hereby authorize medical treatment, and assume the responsibility of all medical treatment, and assume the responsibility of all medical bills, if any.
Adult Participant's Signature *
Date *