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CONSENT AND WAIVER

FOR CFC-YOUTH IN-PERSON ACTIVITY PARTICIPANTS

2025 NE-B CFC-Youth Regional Youth Conference (Pre-Con)

DATE:  Saturday, May 31, 2025

TIME: 8:00 AM to 7:00 PM

LOCATION: Green Acres Center, 4401 Sideburn Road, Fairfax, VA 22030





CONSENT & RELEASE WAIVER FORM

I, the undersigned adult/ parent and/or guardian of the youth, whose name appears below, hereinafter known as “Participant,” hereby give my consent for the Participant to attend the 2025 CFC-Youth Northeast B Regional Youth Conference (Pre-Con) at the Green Acres Center, 4401 Sideburn Road, Fairfax, VA 22030 on Saturday, May 31, 2025.

I hereby agree to fully absolve and release and save and hold harmless Couples For Christ (CFC), which shall include its Ministries (e.g., CFC SFC, CFC HOLD, CFC SOLD, CFC Youth, CFC Kids, Ablaze), organizers, leaders, members, and Green Acres Center from any and all responsibility, liability, claims, lawsuits, damages, costs, etc. relative to any injuries or death to persons or damage to property, directly or indirectly arising out of, in connection with, or incidental to the Participant’s attendance, participation, and involvement in any and all activities within the scope of the 2025 CFC-Youth Northeast B Regional Youth Conference (Pre-Con).

PHOTOGRAPH, VIDEO AND MEDIA CONSENT FORM AND RELEASE

I, the undersigned adult/ parent and/or guardian of the youth, whose name appears below, hereinafter known as “Participant,” hereby voluntarily grant Couples For Christ (CFC), which shall include its Ministries (e.g., CFC SFC, CFC HOLD, CFC SOLD, CFC Youth, CFC Kids, Ablaze), the absolute right and permission to take photographs, digital images and/or videotapes of the Participant, and to use the same or any material in which the Participant may be shown (hereafter individually and collectively, “Materials”), in whole or part, or any reproductions thereof, for any lawful purpose of CFC, including but not limited to use in any CFC publication or promotional material, on the CFC websites, or on any media, and without payment or any other consideration.

I, the undersigned adult/ parent and/or guardian of the youth waive any right I may have to inspect and/or approve the finished product, or any copy, variation or revision thereof, in which the Material may be used, or the Participant's likeness, representation or voice. I hereby release, discharge, and agree to indemnify and hold harmless CFC, its Ministries and officers or representatives, from all claims, demands, causes of action and suit that I/we or the Participant have or may have by reason of this authorization or use of the Materials, including any liability on account of any distortion, alteration, blurring, optical illusion, or use in composite form, whether intentional or otherwise, that may occur or be produced in the taking of the Materials, or in processing leading towards the completion of the finished product, including publication on the internet, in brochures, or any other advertisements or promotional materials.

I represent that I am at least eighteen (18) years of age and fully competent to sign this Consent and Release.


Authorization and Informed Consent

By signing below, I acknowledge having read and foregoing the waiver and certify that I understand its contents and I am signing the same voluntarily.

Today's Date: May 31, 2025






First Participant's Name
First Name*
Last Name*
First Participant's Age Acknowledgment*
First Participant's Date of Birth*
Date of Birth
I certify that I am 18 years of age or older
First Participant's Information:
Medications Currently On:
Known Allergies:
Physical Restrictions:
First Participant's Signature*
Second Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Second Participant's Information:
Medications Currently On:
Known Allergies:
Physical Restrictions:
Third Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Third Participant's Information:
Medications Currently On:
Known Allergies:
Physical Restrictions:
Fourth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Fourth Participant's Information:
Medications Currently On:
Known Allergies:
Physical Restrictions:
Fifth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Fifth Participant's Information:
Medications Currently On:
Known Allergies:
Physical Restrictions:
Sixth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Sixth Participant's Information:
Medications Currently On:
Known Allergies:
Physical Restrictions:
Seventh Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Seventh Participant's Information:
Medications Currently On:
Known Allergies:
Physical Restrictions:
Eighth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Eighth Participant's Information:
Medications Currently On:
Known Allergies:
Physical Restrictions:
Ninth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Ninth Participant's Information:
Medications Currently On:
Known Allergies:
Physical Restrictions:
Tenth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Tenth Participant's Information:
Medications Currently On:
Known Allergies:
Physical Restrictions:
Parent or Guardian's Email Address
Email*
Confirm Email*
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*
Last Name*
Phone*
Parent or Guardian's Age Acknowledgment*
Parent or Guardian's Date of Birth*
Date of Birth
I certify that I am 18 years of age or older
Parent or Guardian's Information:
Medications Currently On:
Known Allergies:
Physical Restrictions:
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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