Loading...

Permission to participate - Recognize accidents may happen when doing fun stuff and accept risks – Choose to come healthy - Hold YFC harmless - Consent to emergency medical treatment and costs – Media release - Behavior agreement for safety

1. RELEASE OF LIABILITY - “I give my permission to participate in YFC activities. I understand accidents can happen when doing fun activities and accept the risks. I or my child agree to come to YFC activities healthy.”

I understand that the opportunity to participate in YOUTH FOR CHRIST/USA, INC., et al (“YFC”) activities is a privilege. I am signing this Release of Liability form on behalf of myself or my minor child. I understand that my child or I may participate in any number of physical activities some of which include, but are not limited to, recreational activities and games and events. I understand that there are certain risks of physical injury or illness associated with these activities. In addition, I understand that there may be other risks associated with activities of which I may not be presently aware.

By signing this Release, I expressly assume these risks for myself or my minor my child, whether they are known or unknown to me at this time and certify that I or my child is healthy and fit to participate in all YFC activities. I release YOUTH FOR CHRIST/USA, INC., including its affiliated chapters, affiliates, and their officers, directors, volunteers, employees, contractors and agents, from any claim that I or my child may have now or in the future against them for any accidental physical or other personal injury, loss of personal property, illness or death caused by infectious and/or contagious diseases or sickness while at camp or other YFC activities, or during YFC travel to and from camp or other YFC activities, and any medical responses to the same, as well as any other claims arising from participation in YOUTH FOR CHRIST/USA, INC. et al activities. This release of liability shall cover (without limitation) all claims for negligence and breach of fiduciary duty asserted by my child, myself or any person made on their behalf. This Release specifically covers claims caused in whole or in part by any U.S. national health crisis, epidemic, pandemic, or similar widespread outbreak of disease whether or not such is formally declared by the U.S. government, the Center for Disease Control or the World Health Organization. YFC reserves the right to follow recommended CDC guidelines related to such pandemic, outbreak or disease and as such may choose at any time to send a participant home if presenting signs of sickness.

2. INDEMNIFICATION – “I agree to hold YFC harmless.”

I hereby agree to defend, indemnify and hold YOUTH FOR CHRIST/USA, INC., including its chapter affiliates, their directors, volunteers, employees, contractors and agents, harmless from any liability asserted by me or my child subsequent to his or her 18th birthday, including reasonable attorney's fees and costs.

3. AUTHORIZATION FOR MEDICAL TREATMENT - “If an accident happens and if I cannot be reasonably reached, I give permission for emergency medical treatment and promise to cover medical costs if treatment is needed.”

I understand it may be necessary to have a medical consent form present for medical professionals in the unlikely event of an injury or condition requiring medical treatment of me or my child. This form gives YFC and its personnel the permission to take me or my child to the nearest, capable medical facility and have any necessary emergency treatment administered.

IF PARTICIPANT IS A MINOR: IN CASE OF EMERGENCY, I UNDERSTAND THAT EFFORTS WILL BE MADE TO CONTACT ME; HOWEVER, IF I CANNOT BE REACHED, I HEREBY GIVE YOUTH FOR CHRIST/USA, INC. AND ITS REPRESENTATIVES THE PERMISSION TO ACT ON MY BEHALF IN SEEKING EMERGENCY MEDICAL TREATMENT FOR MY CHILD IN THE EVENT THAT SUCH TREATMENT IS DEEMED NECESSARY OR ADVISABLE FOR MY CHILD'S HEALTH, SAFETY AND WELFARE. I GIVE PERMISSION TO THOSE ADMINISTERING MEDICAL TREATMENT TO DO SO, USING THE MEASURES DEEMED NECESSARY. I RELEASE YOUTH FOR CHRIST/USA, INC., ITS REPRESENTATIVES, AND ALL MEDICAL PROVIDERS FROM LIABILITY IN ACTING IN THIS REGARD AND RENDERING SUCH MEDICAL TREATMENT. I WILL BE FULLY RESPONSIBLE FOR ALL SUCH MEDICAL EXPENSES.

IF PARTICIPANT IS 18 OR OVER: IN CASE OF EMERGENCY, AND AM UNABLE TO REPRESENT MYSELF, I HEREBY GIVE YOUTH FOR CHRIST/USA, INC. AND ITS REPRESENTATIVES THE PERMISSION TO ACT ON MY BEHALF IN SEEKING EMERGENCY MEDICAL TREATMENT FOR MY PERSON IN THE EVENT THAT SUCH TREATMENT IS DEEMED NECESSARY OR ADVISABLE FOR MY HEALTH, SAFETY AND WELFARE. I GIVE PERMISSION TO THOSE ADMINISTERING MEDICAL TREATMENT TO DO SO, USING THE MEASURES DEEMED NECESSARY. I RELEASE YOUTH FOR CHRIST/USA, INC., ITS REPRESENTATIVES, AND ALL MEDICAL PROVIDERS FROM LIABILITY IN ACTING IN THIS REGARD AND RENDERING SUCH MEDICAL TREATMENT. I WILL BE FULLY RESPONSIBLE FOR ALL SUCH MEDICAL EXPENSES.

4. MEDIA RELEASE - “YFC can use pictures and other media of me or my child participating in YFC activities for promotional purposes.

I hereby grant permission to YOUTH FOR CHRIST/USA, INC. the right to use, reproduce, and/or distribute any photographs, film, video and sound recordings of me and my child, without compensation or approval rights, for use in materials created for purposes of promoting the future activities of YOUTH FOR CHRIST/USA, INC.

5. BEHAVIORAL AGREEMENT – “YFC hates sending participants home, but sometimes they have to. I recognize that.”

I understand that illegal, immoral activity, or behavioral issues may result in the named participant being sent home at the expense of the parent/guardian. Activities would include but are not limited to: reasonable belief of possession and/or use of drugs, alcohol, weapons; sexually aggressive and/or inappropriate behavior; stealing; fighting; etc. YFC leaders will make reasonable effort to contact the parent/guardian to make arrangements before a participant is sent home.

I have read the above waivers/releases and understand what I have read.

I represent that I am the participant named below (if 18 or over) or the legal parent/guardian of the child named below, who is under 18 years of age. In consideration for allowing my child to participate in this activity and ongoing YFC activities, I hereby consent to the foregoing on behalf of my child and agree that this release shall be binding upon me, my child, our heirs, legal representatives and assigns.

 

First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information

School
Current Grade*
5
6
7
8
9
10
11
12
Graduated
Does this participant have any allergies or food restrictions? (IF YES, LIST IN MEDICAL NOTES BELOW)*
No
Yes
Is the student taking any medication? (IF YES, LIST IN MEDICAL NOTES BELOW)*
No
Yes

Medical Information (Allergies, Medication, important notes, etc):
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

Last Name*
Second Participant's Date of Birth*
Second Participant's Information

School
Current Grade*
5
6
7
8
9
10
11
12
Graduated
Does this participant have any allergies or food restrictions? (IF YES, LIST IN MEDICAL NOTES BELOW)*
No
Yes
Is the student taking any medication? (IF YES, LIST IN MEDICAL NOTES BELOW)*
No
Yes

Medical Information (Allergies, Medication, important notes, etc):
Third Participant's Name

First Name*

Middle Name

Last Name*
Third Participant's Date of Birth*
Third Participant's Information

School
Current Grade*
5
6
7
8
9
10
11
12
Graduated
Does this participant have any allergies or food restrictions? (IF YES, LIST IN MEDICAL NOTES BELOW)*
No
Yes
Is the student taking any medication? (IF YES, LIST IN MEDICAL NOTES BELOW)*
No
Yes

Medical Information (Allergies, Medication, important notes, etc):
Fourth Participant's Name

First Name*

Middle Name

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information

School
Current Grade*
5
6
7
8
9
10
11
12
Graduated
Does this participant have any allergies or food restrictions? (IF YES, LIST IN MEDICAL NOTES BELOW)*
No
Yes
Is the student taking any medication? (IF YES, LIST IN MEDICAL NOTES BELOW)*
No
Yes

Medical Information (Allergies, Medication, important notes, etc):
Fifth Participant's Name

First Name*

Middle Name

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information

School
Current Grade*
5
6
7
8
9
10
11
12
Graduated
Does this participant have any allergies or food restrictions? (IF YES, LIST IN MEDICAL NOTES BELOW)*
No
Yes
Is the student taking any medication? (IF YES, LIST IN MEDICAL NOTES BELOW)*
No
Yes

Medical Information (Allergies, Medication, important notes, etc):
Sixth Participant's Name

First Name*

Middle Name

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information

School
Current Grade*
5
6
7
8
9
10
11
12
Graduated
Does this participant have any allergies or food restrictions? (IF YES, LIST IN MEDICAL NOTES BELOW)*
No
Yes
Is the student taking any medication? (IF YES, LIST IN MEDICAL NOTES BELOW)*
No
Yes

Medical Information (Allergies, Medication, important notes, etc):
Seventh Participant's Name

First Name*

Middle Name

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information

School
Current Grade*
5
6
7
8
9
10
11
12
Graduated
Does this participant have any allergies or food restrictions? (IF YES, LIST IN MEDICAL NOTES BELOW)*
No
Yes
Is the student taking any medication? (IF YES, LIST IN MEDICAL NOTES BELOW)*
No
Yes

Medical Information (Allergies, Medication, important notes, etc):
Eighth Participant's Name

First Name*

Middle Name

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information

School
Current Grade*
5
6
7
8
9
10
11
12
Graduated
Does this participant have any allergies or food restrictions? (IF YES, LIST IN MEDICAL NOTES BELOW)*
No
Yes
Is the student taking any medication? (IF YES, LIST IN MEDICAL NOTES BELOW)*
No
Yes

Medical Information (Allergies, Medication, important notes, etc):
Ninth Participant's Name

First Name*

Middle Name

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information

School
Current Grade*
5
6
7
8
9
10
11
12
Graduated
Does this participant have any allergies or food restrictions? (IF YES, LIST IN MEDICAL NOTES BELOW)*
No
Yes
Is the student taking any medication? (IF YES, LIST IN MEDICAL NOTES BELOW)*
No
Yes

Medical Information (Allergies, Medication, important notes, etc):
Tenth Participant's Name

First Name*

Middle Name

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information

School
Current Grade*
5
6
7
8
9
10
11
12
Graduated
Does this participant have any allergies or food restrictions? (IF YES, LIST IN MEDICAL NOTES BELOW)*
No
Yes
Is the student taking any medication? (IF YES, LIST IN MEDICAL NOTES BELOW)*
No
Yes

Medical Information (Allergies, Medication, important notes, etc):
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
A signed copy of this waiver will be sent to the email address you provide.
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*
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.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information

School
Current Grade*
5
6
7
8
9
10
11
12
Graduated
Does this participant have any allergies or food restrictions? (IF YES, LIST IN MEDICAL NOTES BELOW)*
No
Yes
Is the student taking any medication? (IF YES, LIST IN MEDICAL NOTES BELOW)*
No
Yes

Medical Information (Allergies, Medication, important notes, etc):
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.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver - TRY IT FREE!