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Please review and sign this waiver before attending Saint Andrew's High School Youth Trip on July 13-16.



Consent / Waiver / Release:

I hereby give permission to this youth to attend and participate in the activities of the Saint Andrew's Summer Youth Group Trip 2023.


 

I hereby give permission for this youth to ride in any vehicle designated by the adult in whose care this minor has been entrusted while attending and participating in this trip.


 

I will assume all transportation costs for the youth if problems occur during this event and they must be sent home.


 

My child understands that if they are in possession of any illegal drugs, alcohol, guns, and/or fireworks that this will be cause them to be automatically being sent home.


I will take no civil or legal action against the supervising adult(s) or Saint Andrew's Episcopal Church Seattle for the normal care of the minor in their charge.


 

I understand that every effort will be made to contact me in the event of any accident or injury to my child. In the event I cannot be reached, I hereby authorize any supervising adult, in whose care this minor has been entrusted, to consent to whatever medical or surgical treatment may be necessary or advisable by the physician or nurse treating such injuries. I understand that I am responsible for the cost of all medical treatment administered to my child.


I/we give permission for the above named child to be photographed and or/videotaped during the event and the images to be published, reproduced, or distributed by St. Andrew’s Episcopal Church without liability, limitation, or fee.



My child understands that they may be asked to turn off of their cellphone to be more fully present with the group.


I will read and sign the Waiver provided to me by Kamilche Adventures for Kayaking on July 14th starting from Arcadia Point. 



My child will make every effort to participate in sharing in both the 8AM and 10AM worship services on July 23rd 2023. Reflecting during the homily time is optional but encouraged.








Please select who will be participating in the Saint Andrew's Senior High Youth Trip 2023
AdultMinor(s)
1 Minor2 Minors3 Minors4 Minors5 MinorsMore Minors6 Minors7 Minors8 Minors9 Minors10 Minors
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First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Age Acknowledgment*
First Participant's Date of Birth*
I certify that I am 18 years of age or older
First Participant's Information

Please list dietary restrictions or preferences, if any:

Please list allergies, if any:

If a minor, please list any medications. We prefer that youth takes care of their own medication schedule but the lead adult can take over both the safekeeping of the medication and/or scheduling reminders.

Does the participant have any concerns hiking or participating in outdoor recreational games?
Has the participant previously Kayaked?*
No
Yes
Is the participant able to swim?*
No
Yes
Is the participant able to attend and participate in both the 8AM and 10AM worship services on July 23, 2023?*
No
Yes
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*

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

Please list dietary restrictions or preferences, if any:

Please list allergies, if any:

If a minor, please list any medications. We prefer that youth takes care of their own medication schedule but the lead adult can take over both the safekeeping of the medication and/or scheduling reminders.

Does the participant have any concerns hiking or participating in outdoor recreational games?
Has the participant previously Kayaked?*
No
Yes
Is the participant able to swim?*
No
Yes
Is the participant able to attend and participate in both the 8AM and 10AM worship services on July 23, 2023?*
No
Yes
Second Participant's Signature*
Third Participant's Name

First Name*

Last Name*

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

Please list dietary restrictions or preferences, if any:

Please list allergies, if any:

If a minor, please list any medications. We prefer that youth takes care of their own medication schedule but the lead adult can take over both the safekeeping of the medication and/or scheduling reminders.

Does the participant have any concerns hiking or participating in outdoor recreational games?
Has the participant previously Kayaked?*
No
Yes
Is the participant able to swim?*
No
Yes
Is the participant able to attend and participate in both the 8AM and 10AM worship services on July 23, 2023?*
No
Yes
Third Participant's Signature*
Fourth Participant's Name

First Name*

Last Name*

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

Please list dietary restrictions or preferences, if any:

Please list allergies, if any:

If a minor, please list any medications. We prefer that youth takes care of their own medication schedule but the lead adult can take over both the safekeeping of the medication and/or scheduling reminders.

Does the participant have any concerns hiking or participating in outdoor recreational games?
Has the participant previously Kayaked?*
No
Yes
Is the participant able to swim?*
No
Yes
Is the participant able to attend and participate in both the 8AM and 10AM worship services on July 23, 2023?*
No
Yes
Fourth Participant's Signature*
Fifth Participant's Name

First Name*

Last Name*

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

Please list dietary restrictions or preferences, if any:

Please list allergies, if any:

If a minor, please list any medications. We prefer that youth takes care of their own medication schedule but the lead adult can take over both the safekeeping of the medication and/or scheduling reminders.

Does the participant have any concerns hiking or participating in outdoor recreational games?
Has the participant previously Kayaked?*
No
Yes
Is the participant able to swim?*
No
Yes
Is the participant able to attend and participate in both the 8AM and 10AM worship services on July 23, 2023?*
No
Yes
Fifth Participant's Signature*
Sixth Participant's Name

First Name*

Last Name*

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

Please list dietary restrictions or preferences, if any:

Please list allergies, if any:

If a minor, please list any medications. We prefer that youth takes care of their own medication schedule but the lead adult can take over both the safekeeping of the medication and/or scheduling reminders.

Does the participant have any concerns hiking or participating in outdoor recreational games?
Has the participant previously Kayaked?*
No
Yes
Is the participant able to swim?*
No
Yes
Is the participant able to attend and participate in both the 8AM and 10AM worship services on July 23, 2023?*
No
Yes
Sixth Participant's Signature*
Seventh Participant's Name

First Name*

Last Name*

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

Please list dietary restrictions or preferences, if any:

Please list allergies, if any:

If a minor, please list any medications. We prefer that youth takes care of their own medication schedule but the lead adult can take over both the safekeeping of the medication and/or scheduling reminders.

Does the participant have any concerns hiking or participating in outdoor recreational games?
Has the participant previously Kayaked?*
No
Yes
Is the participant able to swim?*
No
Yes
Is the participant able to attend and participate in both the 8AM and 10AM worship services on July 23, 2023?*
No
Yes
Seventh Participant's Signature*
Eighth Participant's Name

First Name*

Last Name*

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

Please list dietary restrictions or preferences, if any:

Please list allergies, if any:

If a minor, please list any medications. We prefer that youth takes care of their own medication schedule but the lead adult can take over both the safekeeping of the medication and/or scheduling reminders.

Does the participant have any concerns hiking or participating in outdoor recreational games?
Has the participant previously Kayaked?*
No
Yes
Is the participant able to swim?*
No
Yes
Is the participant able to attend and participate in both the 8AM and 10AM worship services on July 23, 2023?*
No
Yes
Eighth Participant's Signature*
Ninth Participant's Name

First Name*

Last Name*

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

Please list dietary restrictions or preferences, if any:

Please list allergies, if any:

If a minor, please list any medications. We prefer that youth takes care of their own medication schedule but the lead adult can take over both the safekeeping of the medication and/or scheduling reminders.

Does the participant have any concerns hiking or participating in outdoor recreational games?
Has the participant previously Kayaked?*
No
Yes
Is the participant able to swim?*
No
Yes
Is the participant able to attend and participate in both the 8AM and 10AM worship services on July 23, 2023?*
No
Yes
Ninth Participant's Signature*
Tenth Participant's Name

First Name*

Last Name*

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

Please list dietary restrictions or preferences, if any:

Please list allergies, if any:

If a minor, please list any medications. We prefer that youth takes care of their own medication schedule but the lead adult can take over both the safekeeping of the medication and/or scheduling reminders.

Does the participant have any concerns hiking or participating in outdoor recreational games?
Has the participant previously Kayaked?*
No
Yes
Is the participant able to swim?*
No
Yes
Is the participant able to attend and participate in both the 8AM and 10AM worship services on July 23, 2023?*
No
Yes
Tenth Participant's Signature*
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*
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*
Insurance

Insurance Carrier*

Insurance Policy 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*

Last Name*

Relationship*

Phone*
Parent or Guardian's Age Acknowledgment*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Information

Please list dietary restrictions or preferences, if any:

Please list allergies, if any:

If a minor, please list any medications. We prefer that youth takes care of their own medication schedule but the lead adult can take over both the safekeeping of the medication and/or scheduling reminders.

Does the participant have any concerns hiking or participating in outdoor recreational games?
Has the participant previously Kayaked?*
No
Yes
Is the participant able to swim?*
No
Yes
Is the participant able to attend and participate in both the 8AM and 10AM worship services on July 23, 2023?*
No
Yes
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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