Adult Activity Participation Agreement

Please complete the form below.

Effective September 2026 – August 2027

SPONSORING ORGANIZATION:

Bible Baptist Church, 205 E. Waterford Street, Wakarusa, IN

ACTIVITIES:

This agreement includes participation in but not limited to the following adult activities:

Men’s Basketball
Volleyball
Pickleball
Shooting Activities

PARTICIPANT INFORMATION:

First Name*

Last Name*

Street Address 1*

Street Address 2

Town / City*

State*

Phone*

Email*

Is Bible Baptist Church authorized to approve medical treatment?*

Yes

Is participant covered by medical insurance?*

Yes

Name of Medical Insurer

Separator4

PARTICIPATION AGREEMENT:

I acknowledge that participation in the activities above involves risk and potential injury. In consideration for the
opportunity to participate in any of the above activities, the participant acknowledges and accepts the risks of injury
associated with participation. The participant accepts personal financial responsibility for any injury or other loss
sustained during the activity, or during transportation to and from the activity as well as for any medical treatment
rendered to the participant. Further, the participant releases and promises to indemnify, defend, and hold harmless
the sponsoring organization for any injury arising from the activity, whether such injury arises out of the negligence of
the activity sponsor, the participant or otherwise.

I have read and fully understand this agreement. I am at least 18 years of age, and I voluntarily agree to all of its terms.*

I agree.