2023 Impact Liability Release Form
In consideration for being accepted by Impact Christian Church of Moon Township, PA for participation in activities
sponsored or attended on or between January 1, 2023 to December 31, 2023, we do hereby release, forever discharge and
agree to hold harmless Impact Christian Church and the directors thereof from any and all liability, claims or demands for
personal injury, sickness or death, as well as property damage and expenses, of any nature whatsoever which may be incurred
by the undersigned and the child-participant that occur while said child is participating in the trips or activities noted above.
Furthermore, we hereby assume all risk of personal injury, sickness, death, damage and expenses as a result of participation
in recreation and work activities involved therein.
Furthermore, authorization and permission is hereby given to said church to furnish any necessary transportation, food and
lodging for this participant.
The undersigned further hereby agree to hold harmless and indemnify said church, its directors, employees and agents, for
any liability sustained by such church as the result of negligent, willful, or intentional acts of said participant, including
expenses incurred attendant thereto.
We are the parents or legal guardians of this participant, and hereby grant our permission for him/her to participate fully in
any activity, and hereby give our permission to take said participant to a doctor or hospital and hereby authorize medical
treatment, including but not in limitation to emergency surgery or medical treatment, and assume the responsibility of all
medical bills, if any.
Further, should it be necessary for the participant to return home due to medical reason, disciplinary action or otherwise, we
hereby assume all transportation costs. Finally, my signature authorizes Impact Christian church to take photos of my
child(ren) to be used for promotion in Impact Kids private social media groups.