Northgate Youth General Waiver

Northgate Youth General Waiver

This waiver form is for Northgate Youth's weekly gatherings at Northgate Church. Northgate Youth is for students in grades 5-12. At Northgate Youth, your child will participate in various activities such as, but not limited to: physical activities, small groups, messages, and more. Click next for the information we need from you to get your consent for your child to participate in Northgate Youth.

Student Info
Name of Student*
Phone Number
Optional
Address*
Medical Care Card #
Medical and/or Allergies
Contact Info

This will be our main channel of communication.
Primary Contact Name*
Primary Contact Number*
Secondary Contact Name*
Secondary Contact Number*
Waiver
As the parent/guardian of the above-mentioned student, I hereby grant permission for him/her to participate in all Northgate Youth's weekly gatherings. We release Northgate Foursquare Church, its volunteers, staff, and offsite hosts from all claims resulting in illness, injuries or other damages to property or persons, which may be sustained by your child during their participation at Northgate Youth. In the event of illness or injury, we hereby authorize leaders of the church to obtain appropriate medical assistance and treatment for the above child. Should they choose to act inappropriately over the course of the events, we hold the right to remove and have the student sent home.
I consent to allowing my child's photo/video to be taken for church sharing purposes. Please choose one.*

YesNo
Parent/Guardian Name*
Parent/Guardian Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty:

Student Info