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WAIVER AND RELEASE FORM
Each student volunteer must have his/her parent or guardian sign this form. Each adult volunteer is required to complete this form.
Please print clearly.
Church Attending With__________________________________________
Student/Attendee’s Name________________________________________
Parent/Guardian’s Name_________________________________________
Home Address_________________________________________________
City____________________________State____________Zip__________
Phone(__)___________(__)__________E-Mail______________________
Please check all that apply.
___Male ___Female ___Student Volunteer ___Adult Volunteer
Being aware of all of the activities sponsored by Central Community Ministries (CCM), I hereby consent to the attendee’s participation in said activities. I voluntarily release and forever discharge CCM, its representatives and its directors from any and all liability, claims, actions, or rights of action which are in any way related to the attendee’s participation in CCM’s mission projects. This release is binding on my heirs, personal representatives, and assigns. I acknowledge that I have been given the opportunity to ask questions regarding any aspect of this release and the attendee’s participation with CCM. By signing in the space provided below, I do acknowledge that I have read completely and fully understand all aspects of this release form and agree to its terms in its entirety.
ATTENDEE’S SIGNATURE_______________________DATE_________________
PARENT/GUARDIAN (if attendee is under 18)__________________DATE_____________
Subscribed and sworn before me this_____ day of _____________________, 20___
________________________________
Notary Public Signature and Seal
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