Release of Liability Form

indicates a required answer

Please read over this form carefully. Your name below serves as your digital signature and is binding.

1. *

In consideration of being a participant of ButterCup Hill Academy Co-op (hereafter “BCHA”) and being permitted to utilize the facilities of Community Baptist Church (hereafter “CBC“) I, the undersigned, intending to be legally bound for my family, including any members who are registered with my family and under my guardianship, do hereby:

(9 required)

Affirm that my child(ren) and I have read the PARENT & STUDENT RESPONSIBILITIES together.		Agree to abide by the rules and expectations as presently enforced or as may be amended.
Understand that if anyone under my guardianship violates the rules, we may be asked to leave.		Agree to be responsible for the behavior of my child(ren)
Understand that I will be required to fulfill the co-op job(s) that will be assigned to me.		Agree to pay for any item that my child(ren) damages at the facility in which we meet.
Assume all risk of personal injury that my family’s participation could accrue.		Release and indemnify BCHA from any and all liability, loss, damage, or expense.
Attest that I am of legal age to execute this form as a binding legal document in accordance with it

2. *	Parent Last Name:

3. *	Parent First Name:

4. *	I have read and agree to the terms of the BCHA Release Of Liability.
	By typing my name below, I understand and agree that this form of electronic signature has the same legal force and effect as a manual signature.