theChapel – PreService Childcare

Select the event you plan to attend:*

Please select the Thursday Night Rehearsal Date*

Childcare on Thursday nights will begin at 6:30pm

Please select the Saturday date:

Saturday Pre-Service Childcare drop off starts at 4pm.

Please select the Sunday date:

Sunday Pre-Service Childcare begins at 8am.

Please let us know the date you are requesting for any special service or event.

Start time will vary by event.

Liability Release Form*

In exchange for participation in the activity of Parent’s Night Out organized by theChapel.cc, 8833 Mitchell Blvd, Trinity FL, 34655 and/or use of the property, facilities, and services of theChapel.cc, I agree for myself and (if applicable) for the members of my family, to the following:

1. I agree to observe and obey all posted rules and warnings and further agree to follow any oral instructions or directions given by theChapel.cc, or the employees, representatives or agents of theChapel.cc.

2. I recognize that there are certain inherent risks associated with the above described activity and I assume
full responsibility for personal injury to myself and (if applicable) my family members, and further release and
discharge theChapel.cc for injury, loss or damage arising out of my or my family’s use of or presence upon the
facilities of theChapel.cc, whether caused by the fault of myself, my family, theChapel.cc or other third parties.

3. I agree to indemnify and defend theChapel.cc against all claims, causes of actions, damages, judgments, costs or expenses, including attorney fees, and other litigation costs, which may in any way arise from my or my family’s use of or presence upon the facilities of theChapel.cc.

4. I agree to pay for all damages to the facilities of theChapel.cc caused by my or my family’s negligent,
reckless or willful actions.

5. If signing on behalf of a minor: I consent to the participation of the minor child (name listed below)
in the designated activity, and agree on behalf of the above minor to all the terms and conditions of this
Agreement. By signing this Release of Liability, I represent that I have legal authority over and custody of
the minor child (name listed below).

6. In the event of an injury of a designated minor during the above-described activities, I give my permission to theChapel.cc or to the employees, representatives, or agents of theChapel.cc to arrange for all necessary medical treatment for which I shall be financially responsible. This temporary authority will begin on 2/11/22 and will remain in effect until terminated in writing by the undersigned or 2/12/22 whichever occurs first. theChapel.cc shall have the following powers.
a. The power to seek appropriate medical treatment or attention on behalf of my child as may be required by the circumstances, including without limitation, that of a licensed medical physician and/or hospital;
b. The power to authorize medical treatment or medical procedures in an emergency situation; and
c. The power to make appropriate decisions regarding clothing, bodily nourishment and shelter.

7. Any legal or equitable claim that may arise from participation in the above shall be resolved under Florida
law.

I HAVE READ THIS DOCUMENT AND UNDERSTAND IT. I FURTHER UNDERSTAND THAT BY SIGNING THIS RELEASE, I VOLUNTARILY SURRENDER CERTAIN LEGAL RIGHTS.

I agree to the Liability Release Form

Parent/Guardian Name*

First Last

Email*

Please list each child you would like to register for childcare!*

First Name	Last Name	Age

Click the + sign to the right to add additional children.

Phone

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