2021/22 ICOI Youth Group Registration & Waiver
DISCLAIMER
ICOI and its leaders, directors, officers, employees, contractors, agents, volunteers, members and representatives (collectively referred to as “ICOI”), are not responsible for any injury, loss or damage of any kind whatsoever sustained by any person or their property while participating in events, activities or travel with ICOI and all related activities associated with the ICOI, including injury, loss or damage. ICOI cannot prevent you [or your child(ren)] from becoming exposed to, contracting, or spreading COVID-19 while utilizing ICOI’s services or premises. It is not possible to prevent the presence of the disease. Therefore, if you choose to utilize ICOI’s services and/or enter onto ICOI’s premises you may be exposing yourself to and/or increasing your risk of contracting or spreading COVID-19.

ASSUMPTION OF RISKS
IN CONSIDERATION OF ICOI allowing me or my child to participate in events, activities, or travel with ICOI and all related activities associated with the ICOI, including participation in the Youth Group, and all activities related to the Youth Group (collectively referred to as the “Activities”), I acknowledge that I am aware of the possible Risks, Dangers, and Hazards associated with participation in the Activities including the possible risk of severe or fatal injury to myself or others. I hereby choose to accept the risk of contracting COVID-19 for myself and/or my children in order to utilize ICOI’s services and enter ICOI’s premises. These services are of such value to me [and/or to my children,] that I accept the risk of being exposed to, contracting, and/or spreading COVID-19 in order to utilize ICOI’s services and premises in person.  

RELEASE OF LIABILITY and AGREEMENT
IN CONSIDERATION OF ICOI allowing me or my child to participate in the Activities, I agree on behalf of myself and/or my child:
1. TO ASSUME and ACCEPT ALL RISKS arising out of, associated with or related to my or my child’s participation in the Activities.
2. TO WAIVE and RELEASE ICOI from any and all liability for any loss, damage, injury or expense that I or my child may suffer, or that my next of kin may suffer as a result of my or my child’s participation in the activities due to any cause whatsoever.
3. TO INDEMNIFY and HOLD HARMLESS ICOI from any and all liability for any damage to the personal property of, or personal injury to, any third party resulting from my or my child’s participation in the activities.
4. TO INDEMNIFY and HOLD HARMLESS ICOI from any and all claims, demands, actions, and costs for any loss, injury, damage or expense whatsoever that might arise out of my or my child’s participation in the Activities.
5. I hereby forever release and waive my right to bring suit against ICOI and its owners, officers, directors, managers, officials, trustees, agents, employees, or other representatives in connection with exposure, infection, and/or spread of COVID-19 related to utilizing ICOI’s services and premises.

YOUTH PARTICIPATION CONSENT
Acknowledgment of Participant:
I, the undersigned Participant, understand that I am responsible to act in a safe and responsible fashion, to follow the instructions or directions of the persons in charge of the Youth Group, and to obey requests to comply with safety regulations as directed by the persons in charge of the Youth Group, including designated leaders and drivers of private or public transportation. I will be solely responsible for myself, will wear a seatbelt when available, and will not disturb or distract the driver when using private or public transportation to travel to and from Youth Group activities. At all Youth Group sports events or other activities, I acknowledge that it is my responsibility to obtain and wear appropriate safety equipment. I will not endanger the safety of others or myself at any activities, outings or sports events of the Youth Group or when using private or public transportation for travel to and from such activities. I also understand that I may be photographed or appear in video for such purposes as ICOI deems necessary.

Acknowledgment of Parent or Guardian of Participant:
We, the undersigned Parents or Guardians of the Participant, hereby authorize and consent to the Participant’s involvement in the Youth Group, including any use of private or public transportation deemed necessary by the persons in charge of the Youth Group for Participant travel to and from Youth Group activities, or to the NEAREST SUITABLE MEDICAL or HOSPITAL FACILITY in the event that emergency or other medical treatment not available at the site of a Youth Group activity is deemed advisable. We hereby consent to and authorize such emergency or other medical treatment of the Participant as may be deemed advisable in the event of accident, injury, or illness during the activities of the Youth Group. We also understand that the participant may be photographed or appear in video for such purposes as the ICOI deems necessary.

ACKNOWLEDGEMENT and SIGNATURE

I UNDERSTAND THAT THIS IS A LEGAL AGREEMENT that is binding upon myself and my heirs, executors, administrators, successors and assigns. I HAVE READ AND UNDERSTAND THE TERMS OF THIS AGREEMENT and I ACKNOWLEDGE THAT by entering my name below and submitting this agreement voluntarily, I am agreeing to abide by its terms and I am waiving certain legal rights that my child or I may have.

This Consent, Authorization and Acknowledgment shall be effective from August 27th, 2021.
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Email *
Parent's Name (First, Last) *
Relationship *
Parent's Mobile Number *
Please enter the area code and number. No spaces or special characters.
Parent's Home Phone Number
Please enter the area code and number. No spaces or special characters.
Parent's Email *
Child's Name (First, Last) *
Child's Birthdate *
MM
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YYYY
Child's Gender *
What school does your child attend? *
What is your child's COVID-19 vaccination status? *
Child's Mobile Number
Please enter the area code and number. No spaces or special characters.
Child's Email
Does this child have any health concerns (Allergies, health concerns, medications, disabilities, etc.)? *
If yes, please list them below, along with any special instructions for accommodation.
Do you have another child you wish to register for youth group? *
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