GBR Youth Group Registration & Liability Release 2025&2026

Thank you for participating in a Grace Blue Ridge Church youth group event. We do many fun and exciting things each year, requiring a Liability and Release form to be on file for each participant. Whether attending a special event, serving in our community, or traveling abroad for missions, we strive to make every event safe and fun. The electronic signature of the participant or parent/guardian of participants under 18 years old is equivalent to in-person signatures and will be kept on file for up to one 1 year. We update all participants' releases at the beginning of each Fall Semester.

Your name *

Email address *

Student's Name *

Students Gender *

Male or Female

School *

Grade *

Parent/Guardian 1 Name *

Parent/Guardian 1 Phone *

Parent/Guardian 1 Email *

Parent/Guardian 2 Name

Parent/Guardian 2 Phone

Parent/Guardian 2 Email

Section 1 of 4

I, (“Participant” or "Parent/Guardian of Participant"), acknowledge that I voluntarily seek to use the following facilities or services, or participate in activities of Grace Blue Ridge, (ON/OFF Campus/Community Activities) *

General Liability

Release of Liability Part 1: *

I AM AWARE THAT WHILE GBR HAS ATTEMPTED TO MAKE THESE FACILITIES, SERVICES AND ACTIVITIES AS SAFE AS IS REASONABLY POSSIBLE, THE USE OF THESE FACILITIES OR SERVICES, OR THE PARTICIPATION IN THESE ACTIVITIES, CAN BE HAZARDOUS ACTIVITIES AND THAT I COULD BE SERIOUSLY INJURED OR EVEN KILLED. I AM VOLUNTARILY USING THESE FACILITIES OR SERVICES OR PARTICIPATING IN THIS ACTIVITY WITH KNOWLEDGE OF THE DANGER INVOLVED, AND AGREE TO ASSUME ANY AND ALL RISKS OF BODILY INJURY, DEATH OR PROPERTY DAMAGE, WHETHER THOSE RISKS ARE KNOWN OR UNKNOWN.
I verify this statement typing my name here:

Release of Liability Part 2: *

As consideration for being permitted by GBR to use the facilities or services, or participate in the activities listed above, I forever release, waive, absolve, indemnify, and agree to hold harmless GBR and its directors, officers, employees, volunteers, agents, contractors, and representatives (collectively “Releasees”) from any and all actions, claims, or demands that I, my assignees, heirs, distributees, assigns, guardians, next of kin, spouse and legal representatives now have, or may have in the future, for injury, death, or property damage, related to (i) my use of these facilities or services or participation in these activities, (ii) the negligence or other acts, whether directly connected to these facilities or services or activities or not, and however caused, by any Releasee, or (iii) the condition of the premises where these facilities are located, these services occur and these activities occur, whether or not I am then participating in the facilities, services or activities. I agree for myself, my heirs, and my personal representative, to defend, hold harmless, indemnify, release and forever discharge, to the broadest extent allowed by law, Grace Blue Ridge Church, its trustees, officers, employees, agents, insurers, successors, assigns, from and against any and all claims, demands, actions, or causes of action on account of any damage to real or personal property or any personal injury or death that may result from my participation in the above event.

I also agree that I, my assignees, heirs, distributees, assigns, guardians, next of kin, spouse and legal representatives will not make a claim against, sue, or attach the property of any Releasee in connection with any of the matters covered by the foregoing release. I am agreeing to indemnify Grace Blue Ridge for injuries, damages, or losses I may cause.

I HAVE CAREFULLY READ THIS AGREEMENT AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT BETWEEN MYSELF AND GBR, AND SIGN IT OF MY OWN FREE WILL.

If Signed on Participant’s behalf by Parent/Guardian: I verify that the dangers of the activities and the significance of this Release and Waiver were explained to the Participant and that the Participant understood them, and further, that I execute this with full legal authority to grant the release granted herein on behalf of the Participant.

By typing your name, it is equivalent to signing your signature in person.
(Type participant name if an adult or participant's parent/guardian's name if under 18 here):

Section 2 of 4

Media And Communication Release

Media: As part of documenting our events and activities, we will be taking photos and videos that may be used to share with our Grace Blue Ridge Church family, as well as in publicity for the event on Grace Blue Ridge's social media outlets.
Communications: We are a relational ministry that seeks to come alongside our students and their families. While our programs are of some value, we should view them not as the end but as the means to connect with students relationally, pushing them to know and grow in relationship with Jesus Christ. Our youth leaders are vetted and trained. All adult-to-student communication is done within our approved ministry channels; it is not 100% private, and all communications are saved for 12 months.

Media And Communiation Release Signature: *

By typing your name, you agree to the media release permissions above. I permit for Grace Blue Ridge staff and/or vetted volunteers to contact my child through approved channels (if applicable). Your name is equivalent to your signature in person. (Type participant name if an adult or the participant's parent/guardian's name if under 18 here):

Date: *

This waiver has been signed and executed in Hendersonville, North Carolina, on the following date:
Today's Date:

Section 3 of 4

Medical Release/Consent to Treatment for Minors

If your child is under age 18, we need the Consent to Treatment information on file. Please complete the fields below.

Participants Full Name *

Participants Birthdate *

Address *

Known Allergies (specific medicine, food, etc.) *

Any special dietary or physical constraints or needs *

REQUIRED FOR MINORS - CONSENT TO MEDICAL TREATMENT: *

I (the parent/legal guardian) hereby authorize to the fullest extent permitted under applicable law, each of the adult leaders or designated staff members of Grace Blue Ridge Church to secure medical treatment by medical professionals, at my expense, for any injury or illness suffered by my child, as may be necessary to stabilize my child and to minimize additional injury or effects of illness during the extent of time it takes to contact me, or any other listed Parent/Guardian below for further instructions (which may include, without limitation, anesthetic and surgery if necessary for such purpose). I understand that I will be notified as promptly as possible in the event of an emergency.

By typing your name you agree to this release statement. Typing your name is equivalent to your signature in person.

Date of last tetanus shot (if known)

Family Physician and Phone Number

Insurance Carrier, Phone Number and Policy Number (if applicable)

List of medications taken

Medical note

Anything else we should know in order to care for your child?

Anything else we should know in order to best chaperone and care for your child?

Include any safety concerns we should know about.

Section 4 of 4

Emergency Contacts & Permissions

Emergency Contact Name *

Please provide the first and last name of who to contact if the parent/legal guardian cannot be reached.

Emergency Contact Relationship to Participant *

Emergency Contact Phone Number *

Please list the names of individuals, other than the child's parents/guardians listed above, who are allowed to pick the child up from events.

Phone number

Do you consent to receive text messages?

You are consenting to receive reminders and announcements via text message from Grace Blue Ridge . Text message frequency varies, and message and data rates may apply. Reach out to info@graceblueridge.com with questions. Reply STOP to unsubscribe from messages.