Adult Transportation and Medical Liability

I, the undersigned will be participating in the events and activities of Kingdom Empowerment Christian Church Inc. both on and off church grounds, including the necessary transportation to and from these events and activities.

I acknowledge that I will be transported in a motor vehicle or other modes of transportation as necessary, to include a private owned vehicle, if and when necessary. I recognize that by participating in this activity, as with any activity involving transportation, I may risk personal injury, permanent loss or end of life. I have full knowledge and consent of said risk and I assume any expenses that may be incurred in the event of an accident, illness, incapacitation or end of life.

I, further agree to release and forever discharge Kingdom Empowerment Christian Church Inc., any of it’s staff (paid or volunteers) from any claims and/or accident that may occur on the way to, from, or during an event. I indemnify, defend, and hold harmless Kingdom Empowerment Christian Church Inc and it's staff from all claims made and liabilities assessed against them as a result of any activity or event. I release Kingdom Empowerment Christian Church Inc.and it's staff and all medical providers from liability in acting on my behalf in this regard, rendering such medical treatment. I assume the risk, financial responsibility and hereby give consent for medical treatment if any injury should occur from an event or activity.

By signing below, I am acknowledging that I have read this entire waiver and permission form and I fully understand it and agree to be legally bound by its terms.

* Indicates required field

NAME *

First

Last

CELL PHONE *

Address *

Line 1

Line 2

City

State

Zip Code

Country

IN CASE OF EMERGENCY, PLEASE CONTACT *

First

Last

POC CELL NUMBER *

RELATIONSHIP TO YOU *

EMERGENCY POC #2 *

First

Last

POC #2 CELL NUMBER *

RELATIONSHIP TO YOU *

Emergency Point of Contact must be over the age of 18

TYPE YOUR FULL NAME (SIGNATURE ) *

DATE (MM/DD/YEAR) *

Submit

TRANSPORTATION