2023 Ground Crew Registration

Student Information

Youth Name*

First NameLast Name

Date of Birth*

Date

Grade (Fall 2023)*

T-shirt Size

Does your child have any allergies, chronic illness, or medical conditions?*

YesNo

If yes, please describe.

Is your child prescribed an inhaler?*

YesNo

If yes, please explain any instructions.

Does your child have any medication he is required to take while at Ground Crew?*

I hereby authorize any Guts Church Leader to administer the following non-prescription items as needed to my child. (Please select the authorized medications. Medications not selected will not be administered.)

Acetaminophen (Tylenol)Ibuprofen (Advil)Antacid

Topical and/or first aid items may be utilized by adult leaders unless there is a specific objection by the parent/guardian. Please list any topical or first aid items that are NOT to be used.

Does your child have any food allergies or dietary restrictions?*

Parent/Guardian Information

Parent Name*

First NameLast Name

Cell Number*

E-mail*

example@example.com

Emergency Information

Emergency Contact (other than parent above)*

First NameLast Name

Relationship*

Cell Phone Number*

Release and Waiver of Liability

Please read this form carefully and be aware that you will be waiving and releasing all claims for injuries sustained by you in connection with Guts Church Ground Crew (the “Event”). GUTS Church reserves the right to prohibit participation by those persons they feel would be in danger due to health or physical restrictions. Influence under alcohol or drugs, excessive roughness or disregard to equipment shall also be cause to prohibit participation. I have not consumed any substance that may cause misunderstanding of the words and their meanings as contained in this Release and Waiver of Liability (this “Release”).

In consideration of being allowed to participate in the Event, I, the undersigned, on behalf of myself, my heirs, assigns, personal representatives and next of kin, hereby agree and understand that this Release must be signed by me (or parent/legal guardian, if present, if I am under the age of 18) prior to attending the Event. I hereby acknowledge and represent that I am in good physical condition and have no health conditions or medications that would be negatively affected by active participation in this Event. As a participant, or guardian of a participant of the Event, I recognize and acknowledge that there are certain known and unknown risks of physical injury, property damage or even death which accompany such participation, and I agree to assume the full risk of any exposure, psychological trauma, accidents, injuries such as sprains, breaks, bumps and bruises, including permanent disability or death, and all resulting damages or loss which I may sustain as a result of participating in the Event or any matters incidental thereto. I understand that I will be subjected to loud noises and other people. I take responsibility in knowing my limitations. I recognize that risks and dangers may arise from foreseeable or unforeseeable causes.

I hereby waive and relinquish all claims, including any claims relating to first-aid or medical treatment or lack thereof, against GUTS Church and any of its respective directors, officers, agents, volunteers and employees (collectively, the “Releasees”) that I have as a result of participating in the Event regardless of the cause or Releasees’ own negligence. I do hereby fully release and discharge, and agree to indemnify, hold harmless and defend, GUTS Church and all other Releasees from any and all costs, including attorney’s fees, damages or liability related to injuries, including death, personal injury or damage to, loss or theft of property which I may have or claim, or which may accrue to me on account of my participation in the Event.

I grant and convey to GUTS Church all right, title and interests in any and all photographs, images, video or audio recordings of me or my likeness or voice made by GUTS Church in connection with my participation in the Event.

As a participant, I expressly agree that this Release is intended to be as broad and inclusive as permitted by the laws of the State of Oklahoma, and that this Release shall be governed by and interpreted in accordance with the laws of the State of Oklahoma. I agree that in the event that any clause or provision of this Release is deemed invalid, the enforceability of the remaining provisions of this Release shall not be affected. I have read the above Release and understand that by signing below, I have given up substantial rights and am willingly and voluntarily participating in this Event.

Parent/Guardian Signature

Photo Consent

I, the undersigned parent or legal guardian of the child(children) shown above, give consent to Guts Church, or any party authorized by Guts Church, to use my son’s/my daughter’s photograph taken in connection with Guts Church services or events for any Guts Church purpose including, but not limited to, use in printed publications, social media, video and audio productions, advertising and promotional materials, or other media. I release Guts Church, from any and all liability that may arise in connection with such use. I am the parent or legal guardian of the child named below and have the legal authority to execute this consent and release.

Signature*