Consent and Release form

Event: *

Provide the name of the event.

Date: *

Provide the date of the event.

Time: *

:

am

pm

Provide the time of the event.

Place: *

Provide the location of the event.

Additional information:

I, the undersigned person, hereby consent to my child (named below) participating in the events described in this document. I authorize Jubilee Mennonite Church to take photographs of my child during the activities and release Jubilee Mennonite Church and all persons directly or indirectly representing Jubilee Mennonite Church in the activities described in this document, from any claim relating to any matter whatsoever, including (but not in any way limited to) injury, sickness, death, or loss or damage to property resulting from my child participating in the events described in this document.

Signature of parent/guardian: *

Enter your name here to act as your signature.

Contact phone number: *

Contact email address:

For further informatino, contact Anna Marie Geddert at 204-668-9933 or jmccommunity [at] mymts [dot] net

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