EmailMe Form - KPC Registration Form 2011

KPC Registration Form 2011 ------------------------------------------------------------------------------------- Parental Consent and Liability Statement On behalf of our child, we do hereby release, forever discharge and agree to hold harmless,the Fluvanna Community Church and the directors thereof from any and all liability, claims or demands for personal injury, sickness or death, as well as property damage and expenses of any nature whatsoever which may be in current by child-participant while participating in church- sponsored activities. On behalf of our child we hereby assume all risk of personal injury, sickness, death, damage, and expense 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 and food for this participant in any way as necessary.
By Checking this box, you are acknowledging that you have read and agree with the Parental Consent and Liability Statement. *	Statement Read
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