Youth Group Progressive Dinner (Permission Form/Liability Waiver)

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The event will be Wednesday, December 20 from 6:00-8:30 PM for youth in grades 6-12.

Please have a parent/guardian complete the following form to indicate your participation and sign the liability waiver. Submit a different form for each youth participant.

Parent/Guardian Name *

Youth Participant Name *

Youth Participant Date of Birth *

YYYY

Parent/Guardian Email *

Parent/Guardian Cell Phone *

Parent/Guardian Address *

Emergency Contact Name *

Emergency Contact Phone *

Any Allergies? (Youth Participant) *

Any Medications? (Youth Participant) *

My youth plans to participate in the Progressive Christmas Dinner event. *

Yes

I grant the youth permission to ride with a staff member and/or youth group volunteer to the two offsite destinations listed on the agenda. (All trusted adults have background checks and have completed safe sanctuaries training)

Yes, I grant permission to ride with a trusted adult.

No, I will plan to drive my youth to each of the destinations.

Clear selection

Please check each box below to signify your acknowledgment of each statement. This Agreement (the “Agreement”) is entered into between Noblesville First United Methodist Church on the one hand, and the “Participant” (and his/her Parent/Guardian, if a minor) named above, on the other hand. In consideration of the Participant being given the opportunity to participate in activities, the above signed hereby acknowledges and agrees to the following:

Emergency Authorization. Each Participant authorizes a staff member or volunteer, emergency medical technician, medical treatment facility, and/or doctor of medicine, or associated personnel (each, a “Provider”) to provide the Participant with medical assistance, and/or other treatment and agrees to be financially responsible for the cost of such assistance and/or treatment. Each Participant hereby authorizes emergency transportation of the Participant to a medical treatment facility by ambulance, should a Provider consider it to be warranted, and agrees to be financially responsible for the cost of such transportation.

Assumption of Risk and Waiver. Each Participant acknowledges their understanding that with any travel or event, there are inherent risks and demands. Each Participant hereby asserts that his or her participation is voluntary and that they knowingly assumes all inherent risks.

Each Participant or others making a claim on the Participant’s behalf hereby release, waive, and discharge Noblesville First United Methodist Church employees, directors, officers, volunteers or agents from any and all liability arising from accident, injury, illness, theft, damages, economic loss, or employment disruption that may be sustained by the Participant, or to any property belonging to the Participant, while participating. The Participant further agrees that they will not sue the Church directors, officers, employees, volunteers or agents for any liability arising from accident, injury, illness, theft, damages, economic loss, or employment disruption that may be sustained by the Participant, or to any property belonging to the Participant, while participating in the event.

Media Release. Each Participant grants permission to the Church to use any photographs, images, or likenesses in promotional videos, print or digital marketing, social media, and website communications without remuneration of any type or kind.

Conduct Agreement and Notifications. Each Participant agrees to conduct themselves appropriately and obey all rules, instructions, and warnings, and to notify staff or volunteers immediately of any improper conduct, rules violations or dangerous behavior by any other participants. Each Participant also agrees to notify the staff or volunteers of any injuries sustained (even minor).

Required

I understand and agree that this form is offered as a convenience in lieu of a paper document, but shall constitute the same significance as a paper form.

Yes

No, I prefer to fill out a paper form.

Required

Parent/Guardian Digital Signature *

Submit

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