Appalachian Regional Cooperative


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.





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Signature                                                                       Date





Please list child/ren (under the age of 21) by name and age: