Lighthouse
Baptist
Fellowship
Lighthouse
Baptist Fellowship
5968
Phone:
513-625-5500
Waiver of Liability
Statement
I, the parent or legal
guardian of the child listed below, release Lighthouse Baptist Fellowship, 5968
St. Rt. 132, Goshen, Ohio 45122, together with the church members, form any and
all claims resulting from injury or damage that may be sustained by my child
while participating in the activity listed below at said property.
Name of Youth
Participation: _________________________________________________
Activity: _____________________
Date(s) of Activity: __________ through ___________
Signed:
___________________________________________________ Date: ____________