General Liability and Release Form

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Emergency Contact*

First Last

Emergency Contact Phone Number*

Home Phone Number*

Email*

Insurance Company Name:*

Insurance Company Phone Number*

Full Name of Policy Holder

Insurance Policy Number*

By checking the box below, I hereby give permission for any and all medical attention to be administered in the event of accident, injury, sickness, etc., under the direction of The Sanctuary Fellowship. I also assume the responsibility for the payment of any such treatment. This release is effective for the period of one year from the date given below. It is my intention, by this instrument, to exempt and release The Sanctuary Fellowship from all liability whatsoever for personal injury, property damage, or wrongful death arising from any participation in this event. I hereby personally assume all risks in connection with said event, for any harm, injury, or damage that may befall me while I am participating in this event, including all risks connected therewith, whether foreseen or unforeseen. By checking the box below I agree to all terms and conditions listed above. I I understand and acknowledge that checking the box below acts as my electronic signature.*

I agree to the terms and conditions listed above.

General Liability and Release Form

Medical and Liability Release Form