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CROSS CULTURE KIDS

Pre-Registration

Get a jump on the lines and register your child here prior to Sunday services.

Name

First Name

Last Name

Spouse Name

First Name

Last Name

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Child 1 Name

Birthdate

YYYY

Child 2 Name

Birthdate

YYYY

Child 3 Name

Birthdate

YYYY

Child 4 Name

Birthdate

YYYY

Child 5 Name

First Name

Last Name

Birthdate

YYYY

Special Instructions

Please list any ALLERGIES or special circumstances that would necessitate attention from the Cross Culture staff.

THE NEIGHBORHOOD Waiver of Liability Release/Indemnification of all Claims and Covenant Not to Sue

NOTICE: THIS IS A LEGALLY BINDING AGREEMENT. By signing this agreement, you give up your right to bring a court action to recover compensation or obtain any other remedy for any injury to you or to your property or for your death however caused arising out of your use of the CROSS CULTURE CHURCH(THE NEIGHBORHOOD) facilities, now or any time in the future. I ACKNOWLEDGE AND AGREE that the use of and participation at the CROSS CULTURE CHURCH(THE NEIGHBORHOOD) facility has inherent risks. I have full knowledge of the nature and extent of all risks associated with indoor playground equipment and inflatable’s at CROSS CULTURE CHURCH(THE NEIGHBORHOOD) facility, and on behalf of myself and the children in my guardianship, knowingly and freely assume all such risk, both known and unknown, including those that may arise out of the negligence of other participants. I agree that I shall comply with all, posted safety signs, rules, and verbal instructions as conditions for participation in activities at CROSS CULTURE CHURCH(THE NEIGHBORHOOD). If I observe any hazard during our participation, I will bring it to the attention of the nearest CROSS CULTURE CHURCH(THE NEIGHBORHOOD) employee. In consideration of my participation at the CROSS CULTURE CHURCH(THE NEIGHBORHOOD) facility, I, the undersigned user (or parent/guardian of user), agree to release, indemnify, and hold harmless, on behalf of myself, my heirs, representatives, executors, administrators, and assigns HEREBY DO RELEASE, INDEMNIFY, AND HOLD HARMLESS THE SEABAUGH GROUP, LLC and LITTLE CROSS CULTURE CHURCH(THE NEIGHBORHOOD), its officers, agents, and employees from any cause of action, claims, or demands of any nature whatsoever, including but not limited to, a claim of negligence, which I, my heirs, representatives, executors, administrators, and assigns may now have, or have in the future against CROSS CULTURE CHURCH(THE NEIGHBORHOOD), on account of personal injury, property damage, death, or accident of any kind, arising out of or in any way related to my use of the CROSS CULTURE CHURCH(THE NEIGHBORHOOD) facility, whether that use is supervised or unsupervised, however the injury or damage is caused, including, but not limited to the negligence of CROSS CULTURE CHURCH(THE NEIGHBORHOOD), its officers agents, and employees. I hereby certify that I and/or my child are in good health and that I and/or my child have no physical limitations which would preclude safe participation in the CROSS CULTURE CHURCH(THE NEIGHBORHOOD) program. I further understand that the terms of this agreement are legally binding and I certify that I am signing this agreement, after having read it. BY SIGNING BELOW I CERTIFY THAT I HAVE READ AND UNDERSTAND THE POSTED RULES.

PLEASE TYPE NAME TO ELECTRONICALLY SIGN

First Name

Last Name

Date

YYYY