TEEN INVITATIONAL ACTIVITY CONSENT FORM

TEEN INVITATIONAL ACTIVITY CONSENT FORM
Participant’s name:
Last First
Date of Birth (month/day/year):

MonthDayYear
Date
Age during activity:
For participation in the following activity:

ONE Youth Rally (Birmingham)CavingCross eXamination (Huntsville)PaintballFace To Face Youth Rally (Mobile)Back PackingEpic Encounter (Camp Alamisco)CanoeingUSS Alabama BattleshipRock Climbing
Where:
Leaving:
From:
Returning:
To:
Without restrictions
Please read and select if you have the following:

Please check if you need special consideration or have any restrictions
Special considerations or restrictions:
I understand that participation in the activity involves a certain degree of risk. I have carefully considered the risk involved and have given consent for myself or my child to participate in the activity. I understand that participation in the activity is entirely voluntary and requires participants to abide by applicable rules and standards of conduct. I release the Gulf States Conference, the local council, the activity coordinators, and all employees, volunteers, related parties, or other organizations associated with the activity from any and all claims or liability arising out of this participation.
Signature

Clear
Date:

MonthDayYear
Date
PARENTAL CONSENT: (to be completed and signed by parent/guardian if Participant is under 18 years of age

In case of emergency involving my child, I understand every effort will be made to contact me. In the event I cannot be reached, I hereby give my permission to the medical provider selected by the adult leader in charge to secure proper treatment, including hospitalization, or any other medical care needed to secure the proper treatment for my child.
Parent/guardian printed name:
Will Parent (s) be present at event

YesNo
If parent is going to be present at event he or she must sign an Activity Consent form, print and take to the event as well.
Date:

MonthDayYear
Date
Signature

Clear
Relationship to child:
Date:

MonthDayYear
Date
Area code and telephone numbers (For Emergency Contact):
Person in Charge of the TEEN Email
example@example.com
Name of Person in Charge of TEEN
We have made it available for you to make your payment online. If you are not able you may make payment directly at the event by check or cash. Only leave blank this section.

Thank you!

My Products

CAVINGPayment of Insurance needs to be made before arrival.

$21.00

BACKPACKING

$ Free

CANOEING OVERNIGHT CAMPOUT Product Image

CANOEING OVERNIGHT CAMPOUTPayment must be sent to Greg Myers and the original Registration filled out.

$ Free

ROCK CLIMBING INSURANCEPlease enter a short description.

$6.00

Total

$0.00

Credit Card

This document must be filled out for every participant and a printed copy must be taken to the event for every participant and be in the posession of the person in charge of the minor or participant (older than 18).
Should be Empty: