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This form must be completed once per child being registered.
Vacation Bible School signup and Liability Waiver

Sponsoring Organization: Bella Vista Church
Address: 5100 Belding Rd, Rockford, MI 49341

Phone: 616-874-7727


Description of Activity: Vacation Bible School including outdoor games, relay races, water games, craft time, and snack time


Date of Activity: June 17—20, 2024

Participant Information:
Is participant covered by personal/family medical insurance?
Emergency Contact Information:
Participation Agreement:

I give permission to representatives of Bella Vista Church to seek medical attention if necessary for my child while participating in Bella Vista Church sponsored events.
I acknowledge that participation in the activity described above involves risk to the participant (and to participant’s parents or guardians, if Participant is a minor) and may result in various types of injury including, but not limited to the following: sickness, bodily injury, death, emotional injury, personal injury, property damage and financial damage.
In consideration for the opportunity to participate in the activity described , the participant (or parent/guardian if participant is a minor) acknowledges and accepts the risks of injury associated with participation in or transportation to and from activity. The participant (or parent/guardian) accepts personal financial responsibility for any injury or other loss sustained during the activity or during transportation to and from the activity, as well as for any medical treatment rendered to the participant that is authorized by the sponsor or its agents, employees, volunteers, or any of their repre-sentatives (collectively referred to hereinafter as the “Activity Sponsor”). Further, the participant (or parent/guardian) releases and promises to indemnify, defend, and hold harmless the Activity Sponsor for any injury arising directly or indirectly out of the described Activity or transportation to and from the Activity, whether such injury arises out of the negligence of the Activity Sponsor, the Participant, or otherwise.
If a dispute over this agreement or any claim for damages arises, the Participant (or parent/guardian) agrees to resolve the matter through a mutually acceptable alternative dispute resolution process. If the Participant (or parent/guardian) and the Activity Sponsor cannot agree upon such a process, the dispute will be submitted to a three-member arbitration panel for resolution pursuant to the rules of the American Arbitration Association.

Thanks for Registering! We look forward to seeing you!

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