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GYM RENTAL CONTRACT HOLD HARMLESS AGREEMENT

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GYM RENTAL CONTRACT HOLD HARMLESS AGREEMENT Powered By Docstoc
					                                     550 EAST HAMBURG STREETiPINCKNEY, MI 48169
                          PHONE 734-878-9818 FAX 734-878-9830 • www.livingstonchristianschools.org




                                 GYM RENTAL CONTRACT
                               HOLD HARMLESS AGREEMENT
        The undersigned agrees that he/she will indemnify and hold free and harmless Livingston Christian
Schools, Pinckney, Michigan, its administration, staff, and governing board from any and all claims or
actions for personal injury, sickness or disease, including personal injury, if caused by the undersigned’s
acts or omissions, and the undersigned will pay any and all judgment decrees, costs, including attorney
fees, which may be rendered against Livingston Christian Schools, Pinckney, Michigan, its directors,
officers, agents and employees in any and all such actions or proceedings.

Name of player____________________________________________________Mega Sports Camp

Medical insurance provider_____________________________Policy#__________________________

Signature ____________________________Ph:__________________________Date: July 25 - 28, 2011
( parent or guardian if player is a minor)
                                                     2011 REGISTRATION FORM 
                      Camp Dates:     July 25  –  28        6 – 9 pm       For Ages 8 thru 12
 
Name____________________________________________________________    Gender:    M  or  F 

Address___________________________________________________________________________ 

City_______________________________   State___________________Zip____________________ 

Parent/Guardian(s)Name_________________________________________________ emergency contact 
 
 Phone________________________________________________________________emergency contact 

If other than above, emergency contact_______________________________Phone__________________________ 

Special concerns (allergies, medications, medical conditions, etc.)____________________________________ 
Age on July 25, 2011: _________________   Birthdate:____________________ 

Sports ‐ please list 1st 2nd … choices 
           _________Soccer (bring a soccer ball and shin guards labeled with your name) 
           _________Basketball (bring a basketball labeled with your name and good gym shoes) 
           ________  Cheerleading (wear comfortable shoes and shorts –can be worn under skirt) 

Skill level/experience:        (circle one)             0              1             2             3               4              5 
                                                         beginner‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐advanced   
 
Types of prior experience: (e.g., rec. basketball for 2 seasons, last yrs sport camp, lessons): 
_____________________________________________________________________________ 
 
T‐shirt size (circle)   Youth:    YS     YM     YL      Adult:    S      M      L     XL 
 
_________________________________________________________________________________ 
LIABILITY WAIVER 
I recognize that certain hazards and dangers are inherent in the events and programs of Peoples Church. I acknowledge that although Peoples Church has 
taken safety measures to minimize the risk of injury to participants, Peoples Church cannot insure nor guarantee that the participants, equipment, premises, 
and/or activities will be free from hazards, accidents, and/or injuries. I further recognize and have instructed my child in the importance of knowing and 
abiding by the rules, regulations, and procedures for the safety of activity participants. 
 
In consideration of Peoples Church accepting and permitting my child to attend this activity, retreat, etc and participate in the activities, I agree that Peoples 
Church, a non‐profit corporation, its agents, officers, employees, trustees, and volunteers will not be liable for any injury, death, damage and/or loss to my 
child, and/or anyone claiming on my child’s behalf, and I further agree to hold harmless, indemnify and defend Peoples Church, its officers, agents, employees, 
trustees, and volunteers for and from any and all damage during the time of my child’s attendance and participation with Peoples Church, whether such injury, 
illness, or damage occurs on or off the church premises. 
 
PHOTO RELEASE 
I certify that photographs or videotape pictures of my child participating in the People Church programs may be reproduced 
and utilized in promotional materials for the Church 
 
DATED: Month: ____________________ Day: ________________ Year: ______________ 

Name of Parent/Guardian________________________________________Date______________________ 

Signature of Parent/Guardian_____________________________________________________________________ 

Cost: $20 until June 30, $25 after June 30, please mail this form, the LCS form and payment to:                            Peoples Church
                                                                                                                           500 W Main St
                                                                                                                           Pinckney MI 48169

				
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