LIABILITY RELEASE FORM
Organization Names: Triumph Church, Inc.
Participant’s Name: ___________________________________ DOB: ___________
Campus: ________________ Transportation plan: ☐ TC transport ☐ Private
Event/Activity: Anthem One Night August 2nd
Location: 10255 Eastex Fwy, Beaumont, Texas, 77708
*participants will be transported from TC campuses & back
I understand that participation in the above event/activity could include actions or tasks which might be hazardous to the participant named above.
By signing below, I assume any risk of harm or injury, which might occur to the participant due to his/her/my participation in the event/activity. I release the organizations named above from all liability, costs, and damages, which might arise from participation in the above named event/activity.
If the participant is a minor, I agree that the minor has my consent to participate in the event. I further provide my consent for the organizations named above to seek emergency treatment for the minor if necessary. I agree to accept financial responsibility for the costs related to this emergency treatment.
Sign Here if Participant is an Adult (18+)
Signature of Participant: ________________________________ Date: __________
Sign Here if Participant is a Minor
Name of Parent/Guardian: ________________________________________________
Contact Number: ___________________________
Signature of Parent/Guardian: _____________________________ Date: _________
Contact Name: _______________________________ Relationship: _____________
Contact Number: _______________________________________________________
Participant’s Allergies: _________________________________________________