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Minor Participant Registration

 

 

Informed Consent Waiver for Minors

Thank you for allowing your child to participate in the Sports and Fitness Ministry at Northwest Bible Church. We require you and your child's full understanding and cooperation in ensuring and maintaining the safety and health of all participants, volunteers and employees by reading, agreeing to, and following the policies and procedures of the program. All information provided is reserved for the staff of Northwest and will not be shared with any outside sources. 

Child Participant Section

I agree to be God-honoring, consistent with Northwest’s mission and values and respectful of other participants in my behavior, dress, and music. 

  • Behavior: No profanity, taunting, fighting or other unsportsmanlike conduct will be tolerated.
  • Dress: Appropriate athletic attire is required at all time (shirts, shorts, shoes, etc.). Please avoid crude or distasteful logos, slogans, etc. Ministry staff and approved volunteers reserve the right to invite participants to change and/or remove attire that does not align with the set standards.
  • Music: Music should not contain profanity, crude, or offensive content. Speaker volume should be kept at a level respectful to others in the gym and the surrounding areas.

I Agree

I understand that if I fail to keep any of the above statements, the ministry staff has the right to warn, suspend and/or cancel my privilege to participate in the Sports & Fitness Ministry of Northwest Bible Church. 

I Agree

In consideration of being allowed to use facilities for events and activities, the undersigned acknowledges, appreciates, and agrees that:

  • Attendance at events or activities includes possible exposure to and illness from infectious diseases including but not limited to MRSA, influenza, and COVID-19. While particular rules and personal discipline may reduce this risk, the risk of serious illness and death does exist.
  • I knowingly and freely assume all such risks, both known and unknown, even if arising from the negligence of the releasees or others, and assume full responsibility for my attendance.
  • I willingly agree to comply with the stated and customary terms and conditions for attendance as regards protection against infectious diseases. If, however, I observe and any unusual or significant hazard during my presence, I will remove myself from the building and bring such to the attention of the nearest official immediately.
  • I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, hereby release and hold harmless Northwest Bible Church, their officers, officials, agents, and/or employees, other attendees, sponsoring agencies, sponsors, and owners and lessors of premises used to conduct the event (“releasees”), with respect to any and all illness, disability, death, or loss or damage to person or property, whether arising from the negligence of releasees or otherwise, to the fullest extent permitted by law.

I Agree

Parent/Legal Guardian Section

I agree that I am the parent or legal guardian of the minor participant.

I Agree

I agree that the participant can safely participate in a vigorous exercise program.

I Agree

I agree that I have medical insurance that will cover my child, or ward, if they are injured while participating in the activities. If the participant has or develops any health/medical conditions or concerns, I will notify the appropriate doctor of the participant's intention to participate in a vigorous exercise program prior to registration and participation.

I Agree

I willingly release Northwest Bible Church, and representatives, from liability and responsibility whatsoever and for any claims or causes of action that I or assigns, may have for personal injury resulting from participation. I understand there is inherent risk associated with all activities including suffering from a heart attack; strain or torn muscles, ligaments and tendons; broken bones; head injury or in extreme cases, death as a result of participation.

I Agree

I give Northwest Bible Church permission to render first aid and secure medical assistance to my child, or ward, if I cannot be reached and the condition needs immediate attention.

I Agree

I certify that I, as parent/guardian, with legal responsibility for this participant, have read and explained the provisions in this waiver/release to my child/ward including the risks of attendance and his/her personal responsibilities for adhering to the rules and regulations for protection against communicable diseases. Furthermore, my child/ward understands and accepts these risks and responsibilities. I for myself, my spouse, and child/ward do consent and agree to his/her release provided above for all the Releasees and myself, my spouse, and child/ward do release and agree to indemnify and hold harmless the Releasees for any and all liabilities incident to my minor child’s/ward’s presence or participation in these activities as provided above, EVEN IF ARISING FROM THEIR NEGLIGENCE, to the fullest extent provided by law.

I Agree

By signing below, I certify that I have read the information above and understand that I am in agreement with the policies set forth by the Sports & Fitness Ministry of Northwest Bible Church.

Guardian's Signature

Today's Date: April 22, 2021

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*

Phone*
Second Participant's Date of Birth*
Third Participant's Name

First Name*

Last Name*

Phone*
Third Participant's Date of Birth*
Fourth Participant's Name

First Name*

Last Name*

Phone*
Fourth Participant's Date of Birth*
Fifth Participant's Name

First Name*

Last Name*

Phone*
Fifth Participant's Date of Birth*
Sixth Participant's Name

First Name*

Last Name*

Phone*
Sixth Participant's Date of Birth*
Seventh Participant's Name

First Name*

Last Name*

Phone*
Seventh Participant's Date of Birth*
Eighth Participant's Name

First Name*

Last Name*

Phone*
Eighth Participant's Date of Birth*
Ninth Participant's Name

First Name*

Last Name*

Phone*
Ninth Participant's Date of Birth*
Tenth Participant's Name

First Name*

Last Name*

Phone*
Tenth Participant's Date of Birth*
Participant's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*

Confirm Email*
Participant's Activity
Activities
Yoga
Open Cardio and Weight Room
Open Basketball
Basketball Training
If you are apart of an Athletic Performance Training Group, please select your trainer.
Brian Lonergan
Ricky Zorn
Regis Johnson
If you are part of an invitational basketball group, please select all that apply.
M/F AM - JP Schulze
Wed AM - Ryan O'Dwyer
T/Th AM - Chris Yanniello
Sat AM - Taylor Stell
Businessmen Basketball

If you are apart of another group or team not listed above, please list it here.
Participant's Background

How did you hear about us? (If you are here with a registered participant, please list their name.) *

What are your fitness goals? *

What are your spiritual goals? *
What is your faith background? *
Spiritual, Christian
Spiritual, Non-Christian
Non-Spiritual
None of the Above

Please describe your current spiritual outlook. *
Are you currently involved in a local church?*
No
Yes

If yes, what church?
A parent or court-appointed legal guardian 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*

Phone*
Parent or Guardian's Date of Birth*
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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