Regiment Waiver

Bus Transport Registration

Teen youth program - ages 12-18. Every Wednesday throughout the school year. Please note this form MUST be signed by the youth's parent or legal guardian.
Youth's Name*

First NameLast Name
Youth's Date of Birth*

MonthDayYear
Youth's Phone Number

Area CodePhone Number

Additional Youth
Youth's Name

First NameLast Name
Youth's Date of Birth

MonthDayYear
Date
Youth's Phone Number

Area CodePhone Number

Additional Youth
Youth's Name

First NameLast Name
Youth's Date of Birth

MonthDayYear
Youth's Phone Number

Area CodePhone Number

Additional Youth
Youth's Name

First NameLast Name
Youth's Date of Birth

MonthDayYear
Date
Youth's Phone Number

Area CodePhone Number

Additional Youth
Youth's Name

First NameLast Name
Date of Birth

MonthDayYear
Youth's Phone Number

Area CodePhone Number

Additional Youth
Youth's Name

First NameLast Name
Date of Birth

MonthDayYear
Youth's Phone Number

Area CodePhone Number

Additional Youth
Youth's Name

First NameLast Name
Date of Birth

MonthDayYear
Youth's Phone Number

Area CodePhone Number

Selection Collapse End
Parent/Legal Guardian's Name(s)*
Approved Contact(s) at Youth's Residence(s)
Parent's Phone*

Area CodePhone Number
Additional Cell Number

Area CodePhone Number
Additional Cell Holder's Name(s)
We confirm in your child will need a ride each Wednesday via text message. Please check the box to give us permission to text any and all phone numbers listed in this sign up.*

Check box to give Regiment permission to text you each week.
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Check the box if pickup address is the same as home address
Alternate Pickup Address if Applicable
Zip Code
Pertinent Medical Information
Additional Instructions
Regiment/CWO Release & Waiver Form for Transport
I give permission for my youth to ride the transport on Wednesday evenings to attend Regiment Youth. I give permission and understand that in
addition to going from the pick-up point to the church and back, the youth may also be taken on excursions from time to time on Wednesday evenings, such as trips to other churches, parks, schools, etc. (The Youth Leaders shall exercise due care, including medical attention if/when needed, and caution in seeking the safety of your youth to church and on such excursions.) I release Cornerstone World Outreach, Regiment, and all its members, employees, agents and directors from any claims, liabilities, damages, personal injuries, expenses, or causes of action of whatsoever nature that may arise, (directly or indirectly) out of my youth’s participation in going to and from the church, Regiment, and on said excursions. In addition, the signature below indicates my agreement to pickup my child if problems occur with: 1) drugs, 2) alcohol, 3) rebellion against authority, 4) any other reasonable cause as determined by youth leaders.

In consideration of the Youth Participant being permitted to participate in the Regiment program, I/we do release, waive, forever discharge, and covenant not to sue Regiment/Cornerstone World Outreach, its governing board, officers, agents, employees, and/or any volunteers acting as employees, from and against any and all liability for any harm, injury, damage, claims, demands, actions, causes of action, costs and expenses of any nature which Participant may have or which may hereafter accrue to Participant, arising out of or related to any loss, damage, or injury, including but not limited to suffering and death, that may be sustained by Participant or by any property belonging to the Participant and/or the undersigned, property belonging to or in the care, custody, and/or control of the Participant whether caused by the negligence or carelessness of the Releasees, or otherwise, while Participant is in, on, upon, or in transit to or from the premises where the Activity or any adjunct to the Activity, occurs or is being conducted.
Signature
Name*

First NameLast Name
Today's Date*

MonthDayYear
Date
Once you hit submit, we will receive your submission. You and your youth will receive a text every Wednesday to see if they would like a ride!
Should be Empty:

Bus Transport Registration

Regiment/CWO Release & Waiver Form for Transport