LAUMC Children & Youth Ministry Registration & Release Forms 2020

Please fill out the following registration and release form to sign your child up for LAUMC's 2020-2021 Children & Youth Programs.

I/We, the Guardian of the minors named below, do hereby give my consent to his/her participation in all activities of Los Altos United Methodist Church (LAUMC). The minor and the Guardian desire that the minor engage in activities related to serving or participating in Los Altos United Methodist Church’s activities as a member or participant. The minor and the Guardian are responsible for the minor’s own insurance coverage in the event of personal injury or illness as a result of participation in activities of the Nonprofit.

LIABILITY RELEASE: I/We do hereby for myself and the Minor, and our heirs, executors, and administrators, remise, release, hold harmless, and forever discharge the counselors, leaders, participants, The United Methodist Church, The Annual Conference of the United Methodist Church, Los Altos United Methodist Church and their respective officers, employees, volunteers, members, and affiliated organizations, as well as any and all other participants and/or sponsors of LAUMC, acting officially or otherwise, from all claims, demands, damages, actions or causes of action, liabilities, losses, charges, controversies, costs and expenses of any nature, character, kind, and description, based in law and/or in equity, known or unknown, accrued or not yet accrued, whether anticipated or unanticipated, including the Minors death or any injury the Minor may suffer, or any loss or damage to my property or the Minors property that may occur directly or indirectly from, or arising out of, any cause, while the Minor is participating in an LAUMC event or program, as well as all ground and flight travel incident to such event or program. This Release shall be construed broadly to the maximum extenet permissible under applicable law. THIS RELEASE SHALL REMAIN IN EFFECT UNTIL RESCINDED BY ME/US, IN WRITING.

PICTURE/IMAGE RELEASE & WAIVER: I hereby grant all rights to Los Altos United Methodist Church to use photographs and/or other reproductions of my child/children or their physical likeness for United Methodist publication purposes, whether print, digital, video, or broadcast. I further agree that any uses described may be made without additional compensation or consideration.

MEDICAL RELEASE & WAIVER: I hereby authorize Los Altos United Methodist Church and its representatives to take whatever action may be necessary to obtain emergency medical care for my child(ren) if warranted. These actions may include but are not limited to: attempt to contact a parent/guardian, attempt to contact an emergency contact person designated above, contact 911 for assistance and transportation to a medical facility if recommended by emergency personnel.

I Agree

Please select the children/youth that will be participating...

Minor(s)
1 Minor 2 Minors 3 Minors 4 Minors 5 Minors More Minors 6 Minors 7 Minors 8 Minors 9 Minors 10 Minors

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Child/Youth'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

Emergency Contact's Name*

Emergency Contact's Phone Number*

Other Medical Information

Health Insurance Company Name *

Insurance Policy # *

Family Physician Name *

Family Physician Phone *

Parental/Guardian Information

Parent 1 First Name *

Parent 1 Last Name *

Parent 1 Cell Phone *

Parent 1 Email Address *

Parent 2 First Name

Parent 2 Last Name

Parent 2 Cell Phone

Parent 2 Email Address

Demographic Information

Are you new to LAUMC?*

Yes

Are you interested in church membership?*

Yes

How did you find us?

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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