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Appalachian
Regional Cooperative
Conference
Release
Form
I,
_______________________________________________, will be attending the ARC
Homeschooling Conference on April 9, 2005.
I, the undersigned adult, do hereby release
Bethel Assembly, 515 E. Wilson Blvd., Hagerstown, Maryland, and the Appalachian
Regional Cooperative, Hagerstown, Maryland, as well as 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
participating in the above described activity.
Furthermore, on behalf of my child/ren
participant(s) under the age of twenty-one (21) years, I hereby assume all risk
of personal injury, sickness, death, damage and expenses as a result of
participation in any and all activities involved therein.
__________________________________________
Name
__________________________________________ ______________________
Signature Date
______________________________________________________________
Address
Please list child/ren (under the age of 21)
by name and age:
_______________________________________
_______________________________________
_______________________________________