RELEASE OF LIABILITY AND PARENT PERMISSION FORM
GUTTS
Gaining Understanding/Training To Serve
Lighthouse Community Church
Fort Worth, Texas
817.846.9881



I, the undersigned, do wish to be accepted for participation in GUTTS – Gaining Understanding/
Training To Serve Weekend which is organized by Lighthouse Community Church of Fort Worth, Texas. 
The training activities are designed to allow participants to broaden their understanding of various
Christian values, socio-economic differences, ethnic and racial diversity, cultural appreciation, character
development, and/or enrichment opportunities.  These activities include, but are not limited to, activities
in a lower income neighborhood and among homeless people in the Lancaster Corridor of Fort Worth,
Texas.  I, the undersigned, do acknowledge that the training does involve certain risks.  Participants may
potentially be exposed to physical and psychological risk through elements of nature, travel by car, van,
plane, walking, or other conveyance, and direct contact with people from various backgrounds. 
Risks may also include damage or loss of personal property. Furthermore, immediate medical
treatment may be difficult or delayed due to lack of communication or transportation. 

In consideration of the above, I have, and do hereby, assume all the above risks and any other ordinary
risk incidental to the nature of the program, including risks which are not specifically foreseeable, and
will hold harmless and indemnify Lighthouse Community Church, its Board of Directors, employees,
agents, and/or associates. The terms hereof, and my signature on this document, shall serve as a
release and assumption of risk, and shall bind my heirs, representatives, executors, administrators,
and/or successors.  I state that I am not under, and will not be under the influence of any non-prescribed
chemical substance, including alcohol.  I also state that I will assume responsibility for any damage or
loss to physical property or expenses incurred due to negligent or irresponsible behavior.  I understand
that my participation in this Lighthouse Community Church training is entirely voluntary.

My signature also gives my permission and accepts financial responsibility, as well, for first aid
treatment and/or professional medical attention if needed.  I also give permission for photographing
and videoing of myself during the activities and use of those pictures or video by Lighthouse
Community Church.

_____________________________________________________________________________   Participant’s signature                                                                 Date

_____________________________________________________________________________        Signature of Parent or Guardian if under 18                                              Date