Anthem Waiver Form

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: _________

EMERGENCY CONTACT

Contact Name: _______________________________ Relationship:  _____________

Contact Number: _______________________________________________________

Participant’s Allergies:  _________________________________________________