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Activity: Sr. Youth - Driving Range / Batting Cages (330 Eastchester Ave, Niagara-on-the-Lake, ON L0S 1J0)

Date of Activity: June 3, 2022, 6:00 - 8:00pm

Details of the Activity: Drop off & pick up your child at the Driving Range / Batting Cages. Youth will enjoy the driving range, batting, and visiting together. At least 6 adult leaders will supervise this off-site event.

Dear Parent:

We are planning an activity as part of our programming that requires your permission prior to participation. We have provided you the details of the activity and request that you complete and sign the permission form. Please note that all physical activities have risks. The safety of your child is our primary concern. Precautions will be taken for their well-being and protection.


First Participant's Name

First Name*

Last Name*
First Participant's Date of Birth*
I certify that I am 19 years of age or older
First Participant's Signature*
Second Participant's Name

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

Last Name*
Tenth Participant's Date of Birth*

I hereby consent to the participation of my/our child(ren) in this supervised activity.


While every precaution is taken for the safety and good health of your child, some sports and activities carry with them the inherent risk of personal injury beyond the risks associated with many of the recreational activities at Cornerstone Community Church. I/we understand and accept these risks and agree that by allowing my child to participate in those activities, he/she may be taking part in a recreational activity that presents the potential for personal injury.


I/we, the parents or guardians named below, authorize Cornerstone Community Church Program Personnel to sign a consent for medical treatment and to authorize any physician or hospital to provide medical assessment, treatment or procedures for the participant(s) named above.


I/we, named below, undertake and agree to indemnify and hold harmless Program Personnel, Cornerstone Community Church, and its Leaders from and against any loss, damage or injury suffered by the participant(s) as a result of being part of the activities of Cornerstone Community Church, as well as of any medical treatment authorized by the supervising individuals representing Cornerstone Community Church. This consent and authorization is effective only when participating in or traveling to events sponsored by Cornerstone Community Church.


Declaration of Compliance and Assumption of Risk Related to Coronavirus/COVID-19:

COVID-19 is highly contagious and is known to spread mainly from person-to-person contact. By attending Cornerstone Community Church, you agree to abide by the procedures established by Cornerstone to protect attendees and staff, and you voluntarily assume the risk that you and/or your family may be exposed to or infected by COVID-19 by participating in any of Cornerstone-sanctioned programs. You understand that such exposure to the COVID-19 virus may result in personal injury, illness, permanent disability, and death. You agree to assume all the risks of attendance and participation for you and your family, and accept sole responsibility for any injury to yourself and/or your family, including, but not limited to, personal injury, disability, and death, illness, damage, loss, claim, liability, or expense of any kind that may be experienced in connection with your or your family’s attendance at Cornerstone or participating in Cornerstone programming. You understand and agree to waive any liability against Cornerstone, agents, employees and representatives from any claims, actions, damages, costs or expenses of any kind arising out of or relating thereto.

I have read, understood and agree with above.
Parent or Guardian's Email Address

Email
A signed copy of this waiver will be sent to the email address you provide.
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*
Parent or Guardian's Date of Birth*
I certify that I am 19 years of age or older
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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