BETHEL AFRICAN METHODIST EPISCOPAL CHURCH OF LEAVENWORTH
411 KIOWA STREET
LEAVENWORTH KS 66048
913-682-8454
Vacation Bible School Release of Liability Form
Period Covered: June 22, 2026-June 26, 2026
RELEASE OF LIABILITY: By signing this form, I expressly warrant that the student named
above is capable of withstanding both the physical and mental demands of the activities discussed
above. I also assume all risks of the child participating in the activities, whether such risks are
known or unknown to me at this time. I, the undersigned, for my student, my student’s personal
representatives, assigns, heirs, distributes, guardians, and next of kin (“The Releasers”), hereby
irrevocably and unconditionally release, waive, discharge, and covenant Bethel AME Church of
Leavenworth or its ministers, leaders, employees, volunteers or agents from all claims of any
nature now or hereafter existing whether known or unknown, including but not limited to all
liability to the Releasers, on account of injury to my child or death to my child or injury to the
property of the child, whether caused by the negligence of the Bethel AME Church of
Leavenworth, its ministers, leaders, employees, volunteers, or agents or otherwise, during the
course of my student’s participation in the activities, arising out of or in connection with activities
related to Bethel AME Church of Leavenworth, or any travel connected therewith.
PARENT(s) OR GUARDIAN (s) SIGNATURE: I _____________________________________
represent that I am the parent(s)/guardian(s) of children listed above, who is under 18 years of age. I/We have read the above form and am fully aware of the contents thereof. I/We give permission for the student named above to participate in the activities of Bethel AME Church including any special events/activities. In consideration for allowing the participation
of the student in the activities of Bethel AME Church of Leavenworth, KS, I/We hereby consent to
the above terms on behalf of the child and agree that this form shall be binding