Leduc Community Baptist Church (LCBC) Youth Registration & Waiver Form 2024/2025

Leduc Community Baptist Church (LCBC) Youth Registration & Waiver Form

September 2024 - August 2025
Name of Youth Participant*

First NameLast Name
Birth Date*

DayMonthYear
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
School Attending*
Current Academic Grade*
Alberta Healthcare # of Youth Participant*
Medical Concerns / Allergies / Mental Health Concerns:*

Parent/Guardian Contact #1:*

First NameLast Name
Parent/Guardian Cell Phone Number:*
Please enter a valid phone number.
Email Address:*
example@example.com
Parent/Guardian Contact #2:

First NameLast Name
Parent/Guardian Cell Phone Number:
Please enter a valid phone number.
Parent/Guardian Email Address:
example@example.com

PERMISSION/WAIVER FORM
Functions and Activities It is my understanding that participating in the programs and recreational and other activities Leduc Community Baptist Church is a privilege. Prior to my child/youth’s participation in such activities, I acknowledge that there are certain risks associated with the activities including, by way of example, physical injury due to activity related accidents, physical injury due to transportation related accidents, illness, or even death. In addition, I acknowledge that there may be other risks inherent in these activities of which I may not be presently aware.

Release of Liability By signing this Permission/Waiver Form, I expressly warrant that the child/youth named above is capable of withstanding the physical demands of the activities discussed above. I further release and agree to hold harmless, defend and indemnify Leduc Community Baptist Church and its staff, board, elders, volunteers and agents from and against any and all claims for personal injury (including loss of life) and all other losses or damages, except those caused entirely by the gross negligence or intentional conduct of Leduc Community Baptist Church arising from my or my child’s participation in its activities and programs.

First Aid and Emergency Medical Treatment I recognize that there may be occasions where the child named above may be in need of first aid or medical treatment as a result of an accident, illness, or other health condition or injury. I do hereby give permission for agents of Leduc Community Baptist Church to seek and secure any medical attention or treatment for the child named above, including hospitalization, if in the agent’s opinion such need arises. In doing so, I agree to pay all fees and costs arising from this action to obtain medical treatment. I give permission for attending physicians(s) and other medical personnel to administer any needed medical treatment, including surgery and, again, I agree to pay for the medical treatment.

Special Events and Field Trips I understand that the child/youth named above will be participating in various LCBC Youth Ministry activities from September 1 2024 to August 31 2025. I understand that during this period my child/youth may take part in activities off church property such as: City wide events, Youth trips, Youth Conferences, Missions Trips and other activities consistent with the purposes of the church. I also understand that I may be asked to sign Special Permission Slips in addition to this form. I give permission for my child to leave church property for LCBC Youth Ministry events and/or to ride in any vehicle designated by the approved adult leadership while attending and participating in activities sponsored by LCBC Youth Ministry.

Publicity On occasion, LCBC Youth Ministry takes photographs or makes an audio or video tape recording of children and/or adults involved in church activities. Such photographs or video recordings may be used by staff and participants to remember the activities or participants. In addition, such photographs and audio/visual recordings may be used in LCBC Youth Ministry publications, social media, or advertising materials to let others know about our ministry. I consent to the use of any such, audio or visual record of the child named above to be used, distributed, or displayed as agents of the church see fit. This consent includes but is not limited to: photographs, videotape, and audio recordings. Furthermore, I give permission for the child to be interviewed by the news media, or for such photographs and other audio or visual records to be used by the news media or by other participants on social media.

General Release I hereby release and agree to hold LCBC Youth Ministry and Leduc Community Baptist Church harmless from, and waive on behalf of myself, my heirs, and any personal representatives any and all causes of action, claims, demands, damages, costs, expenses and compensation for damage or loss to myself and/or property that may be caused by any act, or failure to act of the LCBC Youth Ministry, or that may otherwise arise in any way in connection with any LCBC Youth Ministry activities. I understand that this release discharges LCBC Youth Ministry and Leduc Community Baptist Church from any liability or claim that I, my heirs, or any personal representatives may have against the LCBC Youth Ministry with respect to any bodily injury, illness, death, medical treatment, or property damage that may arise from, or in connection to, any activities related to LCBC Youth Ministry. This liability waiver and release extends to the Leduc Community Baptist Church together with all staff, board, and elders.
Emergency Contact Info*
please include a minimum of ONE EMERGENCY CONTACT and relationship to child, etc.
Parent/Guardian Authorization I represent that I am the parent/guardian of the above child, who is under 18 years of age. I have read the above Permission/Waiver Form and am fully familiar with the contents thereof. I give permission for the child named above to participate in the activities of LCBC Youth Ministry, including any special events/activities described above. In consideration for allowing the participation of the child in the activities of LCBC Youth Ministry, I hereby consent to the Permission/Waiver Form, including the Release of Liability above, on behalf of the child, and agree that this Permission/Waiver Form shall be binding upon me, my family, heirs, legal representatives, successors, and assigns. I also understand that it is my responsibility to see that the information on this form is updated when there are any changes in my child’s/youth’s medical status, etc.

By signing I agree I have read and filled out all information on this waiver to the best of my ability. *
Parent/Guardian Signature*
By typing my name in this space I agree to all of the above.
Date Signed*

MonthDayYear

Young Person’s Agreement I understand that LCBC Youth Ministry is a community where all youth are free to come as they are. It is a community for youth to encounter Christ and His undeserved grace. And it is a community to engage in the Holy Spirit’s life transforming mission. I understand that others will have different beliefs, backgrounds, and opinions than me, but I will respect them and show them grace and freedom in Christ. I understand that by taking part in the LCBC Youth Ministry community, I commit to respecting and valuing myself and other people, their beliefs, bodies, personal space, emotions and property through how I speak and act. This includes but is not limited to treating all persons with respect and decency, only being on my phone when necessary, taking care of church property, using my words to build up and not tear down, and respecting and following directions from the leaders put in place at LCBC Youth Ministry.

Disciplinary Policy
One of our top priorities is creating a safe space for youth to engage in community with one another. If an attendee behaves in such a way that puts others at risk, is disrespectful to other youth, volunteers and/or staff, or is inappropriate in words or actions, disciplinary action will be taken. This could look like:

- being sent home early
- being asked to "take a break" (a set time away from LCBC Youth Ministry evenings and events) with a follow up conversation with the LCBC Youth Pastor prior to coming back to LCBC Youth Ministry
-a conversation with parents/guardians with the youth present to discuss behaviour and eligibility in future participation
Youth Participant Signature*
By typing my name in this space I agree to all of the above.
Date Signed*

MonthDayYear
Additional Comments
Anything else you would like LCBC Youth Ministry to know
Should be Empty:

Leduc Community Baptist Church (LCBC) Youth Registration & Waiver Form

PERMISSION/WAIVER FORM