I acknowledge that participation in the activity described on this form involves risk to any participant listed above and to the parent/guardian of any participant who is a minor.

I acknowledge that risks may result in various types of injury including, but not limited to, the following: sickness, exposure to infectious/communicable disease, bodily injury, death, emotional injury, personal injury, property damage, and financial damage.

I accept personal financial responsibility for any injury or other loss sustained during transportation to and from the activity, as well as for any medical treatment rendered to the participant(s) that is authorized by Creekside Church or its agents, employees, volunteers, or any other representatives (collectively referred to as the "activity sponsor").

I release and promise 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(s), or otherwise.

If a dispute over this agreement or any claim for damages arises, I agree 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 in accordance with the rules of the American Arbitration Association.

In case of an emergency or accident, I understand Emergency Medical Services may be summoned via 911 if needed. I authorize said EMS to administer any medical treatment, medication, or appliance deemed necessary by the EMS attendants. I also authorize transportation by EMS to the nearest appropriate medical facility, as determined by EMS. I understand that I will be responsible for payment of all EMS, hospital, and physician charges for emergency services to my child(ren).

I have fully disclosed to All Access Church Consulting all pertinent facts about my child(ren)'s special needs and accept full responsibility for missing information.
Parents may be called to pick up their child if they fail to disclose all information needed to properly and safely care for the child.

I will supply all diapers/wipes for my child(ren), as well as any special food, drinks, snacks they may require.

I give permission for my child(ren) to be photographed or videotaped for promotional purposes.

(As we strive to reach as many families as possible, we may publicize this program through video, websites, and other media in a positive manner. The use of your name, your child's name and/or photo is voluntary. If you are willing to participate in our effort to help other families learn about our special needs ministry, please check the box)