This form covers my child as a permission slip for all events September 01, 2022-August 31, 2023.
AFFILIATED WITH: East Troy Bible Church, Plugged-In
ADDRESS:  2660 North Street, East Troy, WI 53120
PHONE: (262) 642-7604

I acknowledge that participation in the East Troy Bible Church Plugged-In described above involves risk to the Participant, and may result in various types of injury including, but not limited to, the following: sickness, bodily injury, death, emotional injury, personal injury, property damage and financial damage. In consideration for the opportunity to participate in the the East Troy Bible Church Plugged-In, the Participant acknowledges and accepts the risks of injury associated with participation in and transportation to and from Plugged-In. The parent/guardian accepts personal financial responsibility for any injury or other loss sustained during Plugged-In or during transportation to and from the Plugged-in, including being tranported by leaders in their own personal vehicles, loaned vehicles, or rented vehicles used for participation in Plugged-In events, as well as for any medical treatment rendered to the Participant that is authorized by the Sponsor or its agents, employees, volunteers, or any other representatives (collectively referred to hereinafter as the "Activity Sponsor"). Further, the Participant (or parent/guardian) releases and promises to indemnify, defend, and hold harmless the East Troy Bible Church for any injury arising directly or indirectly out of the described Plugged-In or transportation to and from the Plugged-In, whether such injury arises out of the negligence of the Activity Sponsor, the Participant, or otherwise. If a dispute over this agreement or any claim for damages arises, the Participant (or parent/guardian) agrees 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 pursuant to the rules of the American Arbitration Association.

I, the parent or legal guardian, authorize the East Troy Bible Church to photograph and use digital pictures of my child for promotional use for future Plugged-In promotion and youth ministries of the East Troy Bible Church. 1. Use and storage of my child's image, by means of digital or film photography, video photography, audio recording or other documentation, with respect to the activity of Plugged-In. 2. Use of my child's image in printed publications of the East Troy Bible Church. 3. Use of my child's image in electronic publications of of the East Troy Bible Church. 4. Use of my child's image in any Web site created by or for the East Troy Bible Church for its sole benefit. 5. If I am signing this agreement on behalf of a minor child, I hereby warrant that I am the legal parent or guardian of the child and that I have the legal authority to sign this agreement on behalf of the child. 6. 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 I cannot agree with Church upon such a process, the dispute will be submitted to a three-member arbitration panel of the American Arbitration Association for final resolution.

* By entering my in the box above, I am providing my digital signature on this form.

Thank you. Once you submit your registration, we will email a confirmation.  Please save office@etbc.church in your safe emails or check your junk email to be sure to stay up to date.