Participant Release Form (2024)

PARTICIPANT RELEASE FORM 2024

You must fill this out completely. Attach all necessary documents/images. For international trips, you will also need the participant's photo ID (passport, birth certificate, other ID).
Church Information
CHURCH NAME*
YOUTH PASTOR'S NAME:*
YOUTH PASTOR/CHURCH'S EMAIL*
IMPORTANT: Enter the email address for whomever is collecting forms at your church/organization (pastor, assistant, volunteer, etc.). We’ll use this email to send them a copy of your completed form.
TRIP DATES*
TRIP LOCATION*
Participant's Information
PARTICIPANT'S NAME*

First NameLast Name
GOES BY NAME*
Nickname, preferred name
FEMALEMALE
BIRTH DATE*

MonthDayYear
YEAR OF H.S. GRADUATION*
SCHOOL GRADE*
DURING THE SCHOOL YEAR: Choose your current grade. DURING THE SUMMER: Choose your last complete grade.
HOME ADDRESS*

Street Address

Street Address Line 2

CityState

Zip CodeCountry
PARTICIPANT PHONE*

Area CodePhone Number
PARTICIPANT EMAIL*
example@example.com
Parent / Legal Guardian Information

If the need arises, we'll contact the first parent/guardian listed below.
PARENT/LEGAL GUARDIAN NAME 1*
RELATION 1*

mothergrandparentfatherlegal guardianOther
CELL PHONE 1*

Area CodePhone Number
WORK PHONE 1*

Area CodePhone Number
EMAIL 1*
example@example.com
PARENT/LEGAL GUARDIAN NAME 2
RELATION 2

mothergrandparentfatherlegal guardianOther
CELL PHONE 2

Area CodePhone Number
WORK PHONE 2

Area CodePhone Number
EMAIL 2
example@example.com
Emergency Contact Information

Who should we contact if we cannot reach the parent/legal guardian(s) listed above?
EMERGENCY CONTACT*
Someone to contact if parent or guardian is not available.
PHONE*

Area CodePhone Number
Emergency Contact Information

Who should we contact in an emergency?
EMERGENCY CONTACT*
Spouse, parent, etc.
PHONE*

Area CodePhone Number
Participant's Identification & Travel Documents

Please attach the following documents. LeaderTreks officials will keep copies of these documents in case of emergency, but you are responsible for carrying the appropriate ID and travel documents while traveling abroad. Please make sure the attachments are clear and legible.
PASSPORT*
BIRTH CERTIFICATE*
Authorization to Participate or Exclude Participation in LeaderTreks Activities

By entering my electronic signature/initials below, I agree that 1) I, the Participant, am over the age of 18; OR 2) I am the parent or legal guardian of the above named Participant, and am over the age of 18.
As the Participant or parent/legal guardian of the Participant, I hereby agree or give permission for my child to go on trips away from LeaderTreks premises, whether on foot or by vehicle. I agree or give permission for my child to participate in all adventure activities with the following exceptions:*
(enter your initials to agree)
LIST OF EXCEPTIONS: Please exclude my child from participating in the following adventure activities (e.g., water sports, hiking, etc.).
Assumption of Risk and Liability Waiver

Leadership Trips
Coronavirus/COVID-19 Liability Waiver
Signature of Parent/Legal Guardian*

Clear
Signature of Adult Participant*

Clear
Should be Empty:

PARTICIPANT RELEASE FORM 2024

Church Information

Participant's Information

Parent / Legal Guardian Information

Emergency Contact Information

Emergency Contact Information

Participant's Identification & Travel Documents

Authorization to Participate or Exclude Participation in LeaderTreks Activities

Assumption of Risk and Liability Waiver

Coronavirus/COVID-19 Liability Waiver