Waiver and Release Liability – Minor

Sample form for “waiver and release of liability,” for minors participating in church programs. 

Waiver and Release of Liability

(for a Minor Child)

I, the undersigned, am a person at least 18 years of age.  I am the parent or guardian of the minor child named below, and that child desires to voluntarily participate in ___________________________   (the “Program”), sponsored by ________________________________________ (“The Church”).  

I acknowledge that such Program may be hazardous and I hereby assume all responsibility and risk for any accidents, sickness, or other mishaps, including, but not limited to, serious bodily injury, permanent disability, and/or death, that may result to me on the Program.  In connection with my participation in the Program, I hereby waive all rights to any claim, cause of action, and/or the right to file a law suit against The Church, or against any of its affiliates, parent organizations, directors, officers, sponsors, employees, agents, volunteers, successors and assigns.  I further release all such organizations and/or persons from any and all responsibility or liability of any nature whatsoever for any loss or damage to my person or property, including, but not limited to, personal injury and/or death sustained on or through the Program.

               This Waiver and Release of Liability is binding upon my and my child’s personal representatives,  trustees, heirs, successors, beneficiaries, relatives, next of kin or assigns and shall inure to the benefit of all organizations named herein as well as to their directors, officers, sponsors, employees, agents, volunteers, successors and assigns.

            If any provision of this document is held to be invalid or unenforceable, this form shall be construed as if the invalid or unenforceable provision was not contained in the document.

Name of Minor Child: __________________________________          

By signing below I represent that I am the parent or guardian – and if divorced that I have custody – of the above named Minor Child.  I have carefully read this Waiver and Release of Liability.  By my signature, I am stating that I understand, agree to, and accept all of its provisions, and understand that I am giving away substantial legal rights for both myself and for my child.

Signed this _______ day of ______________________, 20___

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          Signature

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          ​Printed Name