New Year's High School Christian Glow Party Liability Form

  • A liability form must be submitted online or in hard copy for your child(ren) to participate in this event. Hard copies are available at Guest and Membership Services in the church foyer.
  • This form must be completed by any parent or legal guardian of the minor(s) listed below. (*Virginia law defines a minor as a person who is under age 18)
  • RELEASE OF LIABILITY STATEMENT I do hereby acknowledge that it is my desire to allow my child(ren) to participate in this church sponsored activity. By signing this document, I agree that my child(ren) is participating in activities that have a potential risk of injury and discharge Harvest Life Changers Church, International and Lyle and Deborah Dukes Ministries of any liability. I further understand that my child(ren) may appear in printed and digital media footage used by Harvest Life Changers Church, International and/or Lyle and Deborah Dukes Ministries. As lawful consideration for my child(ren)’s participation in such activities, I do hereby agree to indemnify and hold harmless Harvest Life Changers Church, International and Lyle and Deborah Dukes Ministries, its officers, employees, volunteers and members of the Board of Directors from any and all claims, lawsuits, demands, causes of action, liability, loss, damage and/or injury, of any kind whatsoever (including without limitation all claims for monetary loss, property damage, equitable relief, personal injury and/or wrongful death) that I and my heirs, distributes, guardians, legal representatives or assigns, now have or may hereafter have arising out of, in any way whatsoever, any acts, omissions or negligence before, during or after my participation in such church sponsored activities on and/or away from church premises. I have carefully read this agreement and fully understand its contents. I am aware that this is a release of liability and assumption of risk agreement, and I sign it as an intentional act. This release of liability and assumption of risk agreement shall remain effective until revoked in writing and delivered to an employee, agent or officer of Harvest Life Changers Church, International and Lyle and Deborah Dukes Ministries, appointed to receive such documentation.
  • *Prince William County Virginia http://www.pwcgov.org/government/courts/circuit/pages/guardian-of-a-minor-qualification.aspx
  • (Please type the letters into the field above!)