Youth

Parent or Legal Guardian Name *

First Name

Last Name

Phone

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Release of Liability - By signing this permission/waiver form, I expressly assume all risks of the child or me participating in Vauxhall Community Church Youth Group activities, whether such risks are known or unknown to me at this time. I further release and hold harmless Vauxhall Community Church and it’s ministers, leaders, employees, volunteers, agents or members from any and all claims arising from participating in any and all Youth Group activities. First Aid and Medical Treatment - I do recognize that there may be occasions where the child named above may be in need of first aid or medical treatment as a result of an accident, illness, or other health condition or injury. I do hereby authorize treatment of a medical emergency, under the direction of a licensed physician contacted during any Youth Group event, which in the opinion of the physician, may endanger his or her life, cause disfigurement, physical impairment, or undue discomfort if delayed. I, as parent or legal guardian, do assume responsibility for any costs connected with such treatment, and hereby release Vauxhall Community Church, and it’s ministers, leaders, employees, volunteers, agents or members, and also the leaders and/or volunteers where the child is attending a Youth Group event, from any and all liability whatsoever relating to any loss, injury, or damage, however caused while participating in any Youth Group event or activity. Publicity - On occasion, photographs and/or audio or video tape recording of Youth Group events may be taken. I do hereby authorize the free publication, display and distribution of such photos or recordings to be used in reporting, advertising and/or promotion of Youth Group. Parent/Guardian Authorization - I represent that I am the parent/guardian of the above child. I have read the above permission/waiver form and am fully aware of its contents. I give permission for the child named above to participate in the activities of Vauxhall Community Church Youth Group program. In consideration for allowing the participation of the child in these activities, I hereby consent to the permission and waiver form, including release of liability above, on behalf of the child, and agree that this permission and waiver form be binding upon me, my family, heirs, legal representatives, successors and assigns. I also understand that it is my responsibility to see that the information on this form is updated when there are changes in my child’s medical status etc. Young Persons Agreement - I agree to participate in the activities of the Vauxhall Community Church Youth Group and to cooperate with the leaders and other young people. I promise to respect God, other persons and property. I understand that my continued participation depends on my support of this agreement. *

I have read the Waiver Form