Page Title

Bethany United Methodist Church
Leisure Ministries

118 West 3rd Street South Summerville, SC 29483
843.873.7261

Step 1. Select sport that are you currently signing up for:

Team name:

Step 2. Fill in personal information:

Please note:
This waiver is only valid for
those participants who are
18 and older.

First name:

Last name:

Step 3. Please read: By
submitting this form, I agree to
participate in an activity sponsored
by Bethany United Methodist
Church. I accept the fact that
injuries may occur while I
participate and I understand that
Bethany United Methodist Church
does not provide insurance. I also
understand that I am responsible
for any injuries that may occur.
I agree that medical attention may
be obtained on my behalf.

Date of birth:

Street

City:

Zip:

Phone:

Email:

Step 4.

Click once

Insurance Waiver for Adults

the crown of
righteousness,
which the
Lord will
award to me 2
Timothy 4:8