Activity Participation Agreement
All Ministry Activities including Transportation
(One form for each family)
Activity Information
Name of Sponsoring Organization: Grinnell Christian Church
Address of Sponsoring Organization: 1331 Hobart St. Grinnell, IA 50112
Name of Coordinator: Various as appointed by GCC
Description of Activity: Any and all Grinnell Christian Church sponsored activities or events starting for date signed below to January 1st, 2019.
Student Name *
Your answer
Date of Birth *
MM
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DD
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YYYY
Grade *
Your answer
Gender *
Allergies/Medical Needs *
Your answer
Student Name
Your answer
Date of Birth
MM
/
DD
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YYYY
Grade
Your answer
Gender *
Allergies/Medical Needs
Your answer
Participant #3 First and Last Name
Your answer
Birthdate
MM
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DD
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YYYY
Grade
Your answer
Gender *
Allergies or Medical Conditions
Your answer
Participant #4 First and Last Name
Your answer
Birthdate
MM
/
DD
/
YYYY
Grade
Your answer
Gender
Allergies or Medical Conditions
Your answer
Parent's Name *
Your answer
Parent phone # *
Your answer
Parent Email
Your answer
Address *
Your answer
Insurance Provider *
Your answer
Policy Number *
Your answer
Is the SPONSOR authorized to approve medical treatment? *
Permission to Post Photos of Student to Social Media Sites (Instagram, Facebook, Snapchat, Website) *
Participation Agreement (Please Read)
In consideration for the opportunity to participate in any GRINNELL CHRISTIAN CHURCH activity, the Participant (or parent/guardian if Participant is a minor) acknowledges and accepts the risks of injury associated with participation in and transportation to and from the activity. The Participant (or parent/guardian if Participant is a minor) accepts personal financial responsibility for any injury related directly or indirectly to the described activity or transportation to and from the activity, unless such injury arises out of the negligence of the Sponsor or otherwise.

If a dispute over this agreement or any claim for damages arises, the Participant (or parent/guardian if Participant is a minor) agrees to resolve the matter through a mutually acceptable alternative dispute resolution process. If the Participant (or parent/guardian if Participant is a minor) and the Sponsor cannot agree upon such a process, the dispute will be submitted to a three-member arbitration panel for final resolution.
Signature (typing your name below will bind you to this Activity Participation Agreement in the same way that physically signing your name would.) *
Your answer
Date *
MM
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DD
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YYYY
Submit
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