Activity waiver

Activity Waiver

Request Submission Date

First and Last Name

I Am the Legal Guardian of the following individuals: Please place their first name, last name, and age

I understand this waiver includes all activities hosted by Bethlehem Baptist Church of Tallahassee doing business as Divine Glory Ministries, Inc. I understand that this waiver will not expire.

Assumptions of the Risks of Release: I recognize that there are certain inherent risks associated with my participating in activities and I assume full responsibility for personal injury to myself and/or any other individuals listed above; and further release and discharge Bethlehem Baptist Church of Tallahassee doing business as Divine Glory Ministries, Inc. for injury, loss, or damage arising out of my engagement, presence upon the facilities of any location activities may take place, whether caused by the fault of myself, Bethlehem Baptist Church of Tallahassee doing business as Divine Glory Ministries, Inc. or other third parties.

Have you read and understod the above statement?

Yes, I have read and understand the statement above.

I affirm all of this information is true and accurate, and this waiver will apply to all activities that I engage in with Divine Glory Ministries, Inc.

Yes, I affirm that all information is accurate and true.

Thank you for your submission