Wufoo

Participant Name *
Date * MM / DD / YYYY
I, the participant listed on this form release, and hereby agree, to hold blameless Kissimmee Christian Church and its employees and agents from any and all claims arising, or which may be asserted by me, or by any member of my family by reason of participating in any activities associated with Kissimmee Christian Church.

I authorize the Minister or Event Coordinator of this activity or any Kissimmee Christian Church staff member to give consent to a physician and/or hospital for emergency medical or surgical treatment while on the premises. It is understood that I will assume any financial responsibility for any expense that may be incurred for any emergency or damages sustained.

I certify that I am covered by adequate insurance. My consent is given below by checking that I agree to these terms. I have read and agree to the information given in this section. *
I agree to these terms I disagree to these terms
I understand and accept that in order to have my special event at Kissimmee Christian Church I must abide by the following guidelines:

* Kissimmee Christian Church is a tobacco, alcohol, and narcotics free campus.
* Kissimmee Christian Church requests all music not be God dishonoring.
* The playlist must be approved by the Event Coordinator 30 days prior to the event.
* The decorative plan must be approved by the Event Coordinator 30 days prior to the event.
* The kitchen usage must be discussed 60 days prior to the event.
* I understand that if I damage the facility and/or my special event does not conclude by 4PM (6PM for receptions) I may incur a penalty fee. *
I agree to these terms I disagree to these terms
The check mark indicates that I have read and understand the terms laid out and that I agree to abide by them.
The checkmark indicates my signature
Do Not Fill This Out