WCCAC Lighthouse Fellowship Off-Site Consent & Registration Form

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Activities with dates: Community Cleanup, 10/27/23; Activate Calgary, 03/01/24; Laser Tag, 04/26/24; Youth Retreat, 03/22/24 - 03/25/24; Wing-Kei Volunteering, 05/31/24; Bowness Park, 06/14/24

Special Information: (recommended clothing, such as a hat; required supplies, like sunscreen, bag lunch, etc.)

Dear Parents:

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

The risks associated with the activities include but are not limited to: (list risks associated with these activities)

I/We voluntarily agree and consent to the participation of my/our youth in these supervised activities.

While every precaution is taken for the safety and good health, some sports and activities carry with them the inherent risk of personal injury beyond the risks associated with many of the recreational activities at Westside Calgary Chinese Alliance Church. I/we understand that my/our Youth is exposed to inherent risks and hazards. I/we accept all these risks and hazards and agree that by allowing my Youth to participate in those activities and acknowledge that I/we will be responsible for any injury or other loss which may occur during my/our Youth's participation of these activities.

I/we, the Parents or guardians named below, authorize the Pastor or one of Westside Calgary Chinese Alliance Church Personnel to sign consent for medical treatment and to authorize any physician or hospital to provide medical assessment, treatment or procedures for the participant named below.

I/we, named below, undertake and agree to indemnify and hold blameless Westside Calgary Chinese Alliance Church, its Personnel, its leaders and the Board from and against any loss, damage or injury suffered by the participant as a result of being part of the activities of Westside Calgary Chinese Alliance Church, as well as of any medical treatment authorized by the supervising individuals representing Westside Calgary Chinese Alliance Church. These consent and authorization are effective only when participating in or traveling to events of Westside Calgary Chinese Alliance Church.

I have read, understood and agreed with above.

Email *

Youth's First Name *

Youth's Last Name *

Youth's Date of Birth *

YYYY

Gender *

Female

Male

Home Address *

Youth's Phone Number *

Alberta Health Card Number *

Family Doctor *

Family Doctor Phone Number *

Allergies (If none, indicate N/A). *

In case of an emergency, contact (Parent/Guardian Contact Number) ________________________ *

Relationship of Parent/Guardian to Youth *

I have read, understood and agree with above. Signature (Full name of Parent/Guardian) *

Date Signed *

YYYY

Do you need a ride to and from church? *

Yes

Other:

Send me a copy of my responses.

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