Waiver & Medical Release Form 2018/19

Youth Friday nights, off-site & small group activities

(Required) If you have more than one child, put their name on the next line
Parent/Legal Guardian's Name *
Parent/Legal Guardian's Name
(Required)
Parent/Legal Guardian's Phone Number *
Parent/Legal Guardian's Phone Number
(Required)
Emergency Contact's Name
Emergency Contact's Name
Emergency Number:
Emergency Number:
(Required)
(Required)

By clicking "I agree", I agree to give my consent for the person/persons identified above and will assume all liability for their participation in this activity/event and any injury that may result during transport to and from the activity/event.

Your child must be covered by Provincial Health Insurance or equivalent medical insurance.

  • I will not hold Family of Faith Church, its officers, agents, employees, assigns or anyone acting on its behalf, responsible or liable for injury occurring to the named person/persons in the course of such activities or such travel.
    Precautions are taken for the safety and health of your child, but in the event of accident or sickness, Family of Faith Church, its staff, its volunteers are hereby released from any liability.

  • I hereby accept financial responsibility for personal items lost by the person/persons identified herein.

  • I authorize Family of Faith Church to transport and to obtain, through a physician of its own choice, any emergency medical care that may become reasonably necessary for the person in the course of such activities/events or such travel, and agree to accept the cost of transportation and/or treatment by medical personnel or facility.

  • In the event that your child requires special medication, x-rays or treatment, the parents/ guardians will be notified immediately. In case of surgical emergency, I hereby give permissions to the physician selected by Family of Faith Church to hospitalize, secure proper treatment for, and to order injection, anesthesia or surgery for my child as named above.

  • At youth events we take pictures to remember events and share the excitement of youth group with others. We may take pictures of your child and use them on the youth web site or in another form of promotional material (e.g brochure, Facebook, etc.) Unless submitted in writing to the church we will assume this is permissible.