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Lakeview Youth Registration & Waiver 2020-2021

Lakeview Youth aims to provide quality programming that is engaging and accessible for all students. 
We place a high priority on safety for all of our participants and leaders. 
Each of our volunteers is required to adhere to a security clearance that includes: 

Criminal Record Check, Reference Checks, and Plan to Protect Training. 

If you ever have any questions at all about our programming, please don't hesitate to contact aden@lakeviewchurch.com for JrHigh and jana-lyn@lakeviewchurch.com for SrHigh

Thank you for taking time to complete our Lakeview Youth Waiver + Registration.

                                                                                                                                                                                                   

ASSUMPTION OF RISK
WAIVER AND RELEASE OF LIABILITY & INDEMNITY

PLEASE READ CAREFULLY

THIS IS A LEGAL DOCUMENT, BY SIGNING THIS DOCUMENT THE PARENTS/GUARDIANS AND YOUNG PERSON (THE “PARTICIPANT”) ARE GIVING UP CERTAIN LEGAL RIGHTS AND ASSUMING CERTAIN OBLIGATIONS. DESPITE PRECAUTIONS TAKEN, ACCIDENTS OCCUR AND THIS AGREEMENT MUST BE SIGNED IN ANTICIPATION OF THAT POSSIBILITY.

To: LAKEVIEW FREE METHODIST CHURCH INC. (“LC”)

The LC Youth program includes, but is not limited to, musical worship, games, Bible teachings, paintball, outdoor adventures, athletics, skateboarding, laser tag, inflatable obstacle courses, DimensionFour Events, amazing race, air soft, nerf blasters, water balloons, eating contests, wall climbing, swimming, and various other activities and events, which may occur on and/or off the LC property and so may also include private and/or public transportation (the “Activities”). The likelihood of serious bodily injury, illness, disease, death and/or property loss or damage during the Activities is not determinable.

LC will make reasonable efforts to ensure the safety of participants and reduce the risks involved in the Activities, but does not accept responsibility for any risks, whether anticipated or not. It is not possible to make the Activities completely safe or free from risk. Participants should not participate unless they fully accept the risks associated with the Activities.

In consideration of LC providing the Youth program in which LC is permitting the Participant to be involved, the undersigned parents/guardians, if applicable, and Participant hereby acknowledge, understand and agree as follows:

(a)  that involvement in and access to some or all of the Activities may involve private and /or public transportation;
(b)  that the Activities (including transportation to and from them) may involve risks of harm to the Participant;
(c)  that unintended harm, accidents, injury, illness, disease, death and/or property damage and/or loss may result as a consequence of participation in the Activities (including transportation to and from them);
(d)  that the undersigned accept full risk and responsibility for the illness of, death of or injury to the Participant or damage or loss to the property of the Participant arising from the Activities (including transportation to and from them);
(e)  that the undersigned waive any rights whatsoever that the undersigned and Participant may have now or in the future against LC and its staff, volunteers, members, directors, officers, leaders, agents, and employees as a result of harm, accidents, injury, illness, disease and death to the Participant or damage or loss to the property of the Participant arising from the participation in the Activities (including transportation to and from them);
(f)  that they release, forever discharge and covenant not to sue and shall indemnify and hold harmless LC, its staff, volunteers, members, directors, officers, leaders, agents, and employees from and in relation to any and all loss, liability, cost, expense, damages, actions, causes of action, suits, claims and demands whatsoever that may arise from any of the Activities (including transportation to and from them), however caused or arising, whether or not as a result of the negligence or wrongful act or omission of LC, its staff, volunteers, members, directors, officers, leaders, agents, and/or employees, or of the Participant;
(g)  that this document will be binding on the heirs, executors, administrators and assigns of the undersigned parents/guardians and the Participant;
(h)  that if any provision hereof is invalid, illegal, or incapable of being enforced by reason of any rule of law or public policy then such provision will be served from and will not affect any other provision contained herein, and this instrument will be read as if such invalid, illegal or unenforceable provision had never been contained herein and all other provisions hereof will, nevertheless remain in full force and effect and no provision will be deemed to be dependent upon any other provision;
(i)  that a signed copy of this document provided by way of facsimile transmission or electronic transmission shall be as binding upon the undersigned as an originally signed copy.

The undersigned acknowledge that they have read this document and understand that legal rights are being affected by this document. The undersigned agree to be bound by the terms and provisions of this document.

I Agree

Today's Date: August 7, 2020

First Participant's Name

First Name*

Last Name*
First Participant's Date of Birth*
First Participant's Information
Gender *
Male
Female

Cell Phone:

Email Address

School *
Grade*
Participant Lives With*

If Other:

MEDICAL INFORMATION 


Hospitalization #

Allergies:

Medications We Should Be Aware Of:

Health/Condition Special Care We Should Be Aware Of:
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's Information
Gender *
Male
Female

Cell Phone:

Email Address

School *
Grade*
Participant Lives With*

If Other:

MEDICAL INFORMATION 


Hospitalization #

Allergies:

Medications We Should Be Aware Of:

Health/Condition Special Care We Should Be Aware Of:
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Third Participant's Information
Gender *
Male
Female

Cell Phone:

Email Address

School *
Grade*
Participant Lives With*

If Other:

MEDICAL INFORMATION 


Hospitalization #

Allergies:

Medications We Should Be Aware Of:

Health/Condition Special Care We Should Be Aware Of:
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information
Gender *
Male
Female

Cell Phone:

Email Address

School *
Grade*
Participant Lives With*

If Other:

MEDICAL INFORMATION 


Hospitalization #

Allergies:

Medications We Should Be Aware Of:

Health/Condition Special Care We Should Be Aware Of:
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information
Gender *
Male
Female

Cell Phone:

Email Address

School *
Grade*
Participant Lives With*

If Other:

MEDICAL INFORMATION 


Hospitalization #

Allergies:

Medications We Should Be Aware Of:

Health/Condition Special Care We Should Be Aware Of:
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information
Gender *
Male
Female

Cell Phone:

Email Address

School *
Grade*
Participant Lives With*

If Other:

MEDICAL INFORMATION 


Hospitalization #

Allergies:

Medications We Should Be Aware Of:

Health/Condition Special Care We Should Be Aware Of:
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information
Gender *
Male
Female

Cell Phone:

Email Address

School *
Grade*
Participant Lives With*

If Other:

MEDICAL INFORMATION 


Hospitalization #

Allergies:

Medications We Should Be Aware Of:

Health/Condition Special Care We Should Be Aware Of:
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information
Gender *
Male
Female

Cell Phone:

Email Address

School *
Grade*
Participant Lives With*

If Other:

MEDICAL INFORMATION 


Hospitalization #

Allergies:

Medications We Should Be Aware Of:

Health/Condition Special Care We Should Be Aware Of:
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information
Gender *
Male
Female

Cell Phone:

Email Address

School *
Grade*
Participant Lives With*

If Other:

MEDICAL INFORMATION 


Hospitalization #

Allergies:

Medications We Should Be Aware Of:

Health/Condition Special Care We Should Be Aware Of:
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information
Gender *
Male
Female

Cell Phone:

Email Address

School *
Grade*
Participant Lives With*

If Other:

MEDICAL INFORMATION 


Hospitalization #

Allergies:

Medications We Should Be Aware Of:

Health/Condition Special Care We Should Be Aware Of:
Parent or Guardian's Email Address

Email
A signed copy of this waiver will be sent to the email address you provide.
Parent / Guardian 1 Information

Parent / Guardian First Name *

Parent / Guardian Last Name *

Parent / Guardian Cell Phone
Who would you like to be the Primary Contact? *
Parent/Guardian 1
Parent/Guardian 2
Do you attend Lakeview Church?*
No
Yes
Parent / Guardian 2 Information

Parent / Guardian 2 First Name

Parent / Guardian 2 Last Name

Parent / Guardian 2 Cell Phone

Parent / Guardian 2 Email
Family Contact Information

Mailing Address *

Mailing Address

City *

Postal Code *

Home Phone
PHOTOGRAPHIC RELEASE

We try to capture the moments at Lakeview Youth and share those memories with our community via Instagram and Facebook. Our team always strives to be respectful and honouring of our students whenever we are making any photographs or videos public. 

I hereby grant permission to the leaders of Lakeview Youth to photograph and/or video record the named Participants for program and general church use including, but not limited to, highlight videos, photo directories, social media, and website galleries.*
Yes
No
E-MAIL LISTS
Would you like to receive email updates from Lakeview Youth regarding upcoming events, program info, and other exciting stuff?*
Yes
No
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Relationship*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information
Gender *
Male
Female

Cell Phone:

Email Address

School *
Grade*
Participant Lives With*

If Other:

MEDICAL INFORMATION 


Hospitalization #

Allergies:

Medications We Should Be Aware Of:

Health/Condition Special Care We Should Be Aware Of:
Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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