LCC Youth Release form

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This is the release form for LCC Youth events.

Email *

Student Name *

Student Date of Birth *

YYYY

Release statement

As a parent / guardian of above minor youth and participant in the programs of Life Community Church student ministries, I do hereby release, forever discharge and hold harmless Life Community Church, Paso Robles, and the directors / pastors / volunteers thereof, from any and all liability, claims, or demands for personal injury, sickness or death, as well as property damage and expenses.

This release covers transportation provided by Life Community Church and its representatives who are properly licensed to drive in the state of California; also meetings on the Life Community Church property or any other site during programs and activities; also consent to emergency medical or dental treatment, including examination, diagnosis, treatment, anesthetic, and surgical treatment, the undersigned agrees to pay all costs and expenses.

Parent / Guardian Name *

Relationship to the Student *

Address *

Emergency Contact Name *

Emergency Contact Number *

Can LCC Youth use photos of or containing your student for social media purposes? *

Yes

Digital Signature

By completing this form you agree with the stated terms of the release, and can sign by writing your full legal name as the parent / guardian below.

Type your full name *

I agree to the terms and conditions of the release. *

Yes I agree - your answers will be recorded

Send me a copy of my responses.

Submit

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