65 Cash only
^ƚƵĚĞŶƚ͗ͺͺͺͺͺͺͺͺͺͺͺͺͺͺͺͺͺͺͺͺͺͺͺͺƉĂŝĚĐĂƐŚΨͺͺͺͺͺͺͺͺͺͺͺͺ͘ĂƚĞ͗ͺͺͺͺͺͺͺͺͺͺͺͺͺͺͺͺͺͺͺ
Date:_________________________
Student Ministry Pleasant Valley Baptist Church 781-5959, ext. 227
SM Leader Signs:_________________________________________
http://www.swingsandpaintball.com/paintball.htm Leave 7:00am Friday, Oct. 26, 2012 at PV South entrance. Arrv back at PVBC South door about Midnight to 12:30am.
This is your receipt that you have paid.
First 50 students paying cash go.
Thank you for your payment of $65 in cash.
NO CHECKS.
6WXGHQW·VQDPHBBBBBBBBBBBBBBBBBBBBBBBBB
$65 Cash only.
(SM Leaders only)
Parents must sign both Release Forms.
t,dzKhE dKZ/E'Θt Z͗ xdĞŶŶŝƐƐŚŽĞƐ;EK ^E> ^Žƌ&>/W-‐&>KW^Ϳ xůŽƚŚĞƐĨŽƌWĂŝŶƚĂůů x>ŽŶŐƐůĞĞǀĞƚ-‐ƐŚŝƌƚ xDŽŶĞLJĨŽƌůƵŶĐŚΛ >ĂŵďĞƌƚƐ-‐ΨϮϬ zŽƵƌΨϲϱƉĂLJŵĞŶƚƚŽ ƉĂƌƟĐŝƉĂƚĞŝŶĐůƵĚĞƐ WĂŝŶƚĂůůĞƋƵŝƉŵĞŶƚ͕ ĨĞĞƐĂŶĚĚŝŶŶĞƌĂƚ ŽĞŶŶŝŐ^ƉŽƌƚ^ǁŝŶŐƐ ΘKnjĂƌŬWĂŝŶƚďĂůů͘
ǤʹǡʹͲͳʹ Ƭ
Participant Information As a parent or legal guardian, I _____________________________________________
;WĂƌĞŶƚ͛ƐƐŝŐŶĂƚƵƌĞͿ
A.
hereby give permission for my child, ______________________________________
to participate in Friday, Oct. 26, 2012 Barn Swing-Paint Ball event at Doennig
;^ƚƵĚĞŶƚ͛ƐŶĂŵĞͿ
Sport Swings and Ozark Paintball in Ozark, MO.
B.
Give PVBC adult sponsors authorization to acquire medical attention for any injury or illness.
͘
hŶĚĞƌƐƚĂŶĚƚŚĂƚWůĞĂƐĂŶƚsĂůůĞLJĂƉƟƐƚŚƵƌĐŚĂŶĚĂĚƵůƚƐƉŽŶƐŽƌƐĐĂŶŶŽƚĂƐƐƵŵĞƌĞƐƉŽŶƐŝďŝůŝƚLJ
ĨŽƌĂĐĐŝĚĞŶƚŽƌŝŶũƵƌLJƚŽƉĂƌƟĐŝƉĂŶƚƐ͘ ͘ /͕ƚŚĞĂďŽǀĞ-‐ƐŝŐŶĞĚƉĂƌĞŶƚŽƌůĞŐĂůŐƵĂƌĚŝĂŶŽĨƚŚĞŵŝŶŽƌŶĂŵĞĚĂďŽǀĞ͕ĚŽŚĞƌĞďLJĂƵƚŚŽƌŝnjĞƚŚĞĐŽŶƐĞŶƚĨŽƌWůĞĂƐĂŶƚ sĂůůĞLJĂƉƟƐƚŚƵƌĐŚƚŽǀŝĚĞŽŽƌƚĂŬĞƉŚŽƚŽƐŽĨŵLJĐŚŝůĚĨŽƌŵŝŶŝƐƚƌLJŽƌƉƌŽŵŽƟŽŶĂůƉƵƌƉŽƐĞƐ͘
Hold Harmless Agreement
I, ________________________, custodial parent and legal guardian for minor, _______________________, acknowledges that my child will participate in 'RHQQLJ6SRUW6ZLQJVDQG2]DUN3DLQWEDOOLQ
2]DUN02Trip sponsored by Pleasant Valley Baptist Church, Liberty, Mo. I understand that participation in this activity might result in injury and I assume responsibility for any and all medical and related costs that might result. I also give permission to the adult sponsors of the activity to seek medical attention as they deem necessary in my absence. Further, I release and forever discharge Pleasant Valley Baptist Church, and any other ministry/ organization involved and each of their respective members, employees, officers, directors and rep- resentatives from any and all claims for any and all injuries that might be incurred. Signed _____________________________________ Date _____________ (must be signed by parent)
&XVWRGLDO3DUHQWRU/HJDO*XDUGLDQ
Date:_________________________
Student Ministry Pleasant Valley Baptist Church 781-5959, ext. 227
SM Leader Signs:_________________________________________
http://www.swingsandpaintball.com/paintball.htm Leave 7:00am Friday, Oct. 26, 2012 at PV South entrance. Arrv back at PVBC South door about Midnight to 12:30am.
This is your receipt that you have paid.
First 50 students paying cash go.
Thank you for your payment of $65 in cash.
NO CHECKS.
6WXGHQW·VQDPHBBBBBBBBBBBBBBBBBBBBBBBBB
$65 Cash only.
(SM Leaders only)
Parents must sign both Release Forms.
t,dzKhE dKZ/E'Θt Z͗ xdĞŶŶŝƐƐŚŽĞƐ;EK ^E> ^Žƌ&>/W-‐&>KW^Ϳ xůŽƚŚĞƐĨŽƌWĂŝŶƚĂůů x>ŽŶŐƐůĞĞǀĞƚ-‐ƐŚŝƌƚ xDŽŶĞLJĨŽƌůƵŶĐŚΛ >ĂŵďĞƌƚƐ-‐ΨϮϬ zŽƵƌΨϲϱƉĂLJŵĞŶƚƚŽ ƉĂƌƟĐŝƉĂƚĞŝŶĐůƵĚĞƐ WĂŝŶƚĂůůĞƋƵŝƉŵĞŶƚ͕ ĨĞĞƐĂŶĚĚŝŶŶĞƌĂƚ ŽĞŶŶŝŐ^ƉŽƌƚ^ǁŝŶŐƐ ΘKnjĂƌŬWĂŝŶƚďĂůů͘
ǤʹǡʹͲͳʹ Ƭ
Participant Information As a parent or legal guardian, I _____________________________________________
;WĂƌĞŶƚ͛ƐƐŝŐŶĂƚƵƌĞͿ
A.
hereby give permission for my child, ______________________________________
to participate in Friday, Oct. 26, 2012 Barn Swing-Paint Ball event at Doennig
;^ƚƵĚĞŶƚ͛ƐŶĂŵĞͿ
Sport Swings and Ozark Paintball in Ozark, MO.
B.
Give PVBC adult sponsors authorization to acquire medical attention for any injury or illness.
͘
hŶĚĞƌƐƚĂŶĚƚŚĂƚWůĞĂƐĂŶƚsĂůůĞLJĂƉƟƐƚŚƵƌĐŚĂŶĚĂĚƵůƚƐƉŽŶƐŽƌƐĐĂŶŶŽƚĂƐƐƵŵĞƌĞƐƉŽŶƐŝďŝůŝƚLJ
ĨŽƌĂĐĐŝĚĞŶƚŽƌŝŶũƵƌLJƚŽƉĂƌƟĐŝƉĂŶƚƐ͘ ͘ /͕ƚŚĞĂďŽǀĞ-‐ƐŝŐŶĞĚƉĂƌĞŶƚŽƌůĞŐĂůŐƵĂƌĚŝĂŶŽĨƚŚĞŵŝŶŽƌŶĂŵĞĚĂďŽǀĞ͕ĚŽŚĞƌĞďLJĂƵƚŚŽƌŝnjĞƚŚĞĐŽŶƐĞŶƚĨŽƌWůĞĂƐĂŶƚ sĂůůĞLJĂƉƟƐƚŚƵƌĐŚƚŽǀŝĚĞŽŽƌƚĂŬĞƉŚŽƚŽƐŽĨŵLJĐŚŝůĚĨŽƌŵŝŶŝƐƚƌLJŽƌƉƌŽŵŽƟŽŶĂůƉƵƌƉŽƐĞƐ͘
Hold Harmless Agreement
I, ________________________, custodial parent and legal guardian for minor, _______________________, acknowledges that my child will participate in 'RHQQLJ6SRUW6ZLQJVDQG2]DUN3DLQWEDOOLQ
2]DUN02Trip sponsored by Pleasant Valley Baptist Church, Liberty, Mo. I understand that participation in this activity might result in injury and I assume responsibility for any and all medical and related costs that might result. I also give permission to the adult sponsors of the activity to seek medical attention as they deem necessary in my absence. Further, I release and forever discharge Pleasant Valley Baptist Church, and any other ministry/ organization involved and each of their respective members, employees, officers, directors and rep- resentatives from any and all claims for any and all injuries that might be incurred. Signed _____________________________________ Date _____________ (must be signed by parent)
&XVWRGLDO3DUHQWRU/HJDO*XDUGLDQ
