Youth Waiver 2025

WFMC YUP/GET ROOTED Waiver & Parental Consent Form
Emergency Medical Release and Liability Waiver Form 2025
General Information
Student's Name*
Birth Date

MonthDayYear
School Currently Attending*
Grade*
Address*

Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student's Cell Phone*
Student's Home Phone
Student's Email*
example@example.com
Family Email*
example@example.com
Emergency Information
Parent/Guardian Information
Mother's Name
Mother's Home Phone #
Please enter a valid phone number.
Mother's Cell Phone #
Please enter a valid phone number.
Father's Name
Father's Home Phone #
Please enter a valid phone number.
Father's Cell Phone #
Please enter a valid phone number.
Additional Emergency Contacts

In an emergency when parent/guardian cannot be reached, please contact the following:
Contact #1
Name
Relationship to Student
Home Phone #
Please enter a valid phone number.
Cell Phone #
Please enter a valid phone number.
Contact #2
Name
Relationship to Student
Home Phone #
Please enter a valid phone number.
Cell Phone #
Please enter a valid phone number.
Health/Medical Information

This authorization for Emergency Medical Treatment must be completed before participant can participate in any activities. Treatment for injury will be based on information provided herein.
Health Concerns
Please identify any allergies include foods health problems medications or other health concerns
Family Physician*
Physician's Phone #*
Dental Provider*
Dental Provider's Phone*
Medical/Hospital Insurance Company*
Group #*
Policy Holder's Name*
Policy #*
Additional Information that may be helpful
Waiver and Consent
DISCLAIMER

Williamston Free Methodist Church, YUP/Get Rooted and its leaders, directors, officers, employees, contractors, agents, volunteers, mem- bers and representatives (collectively referred to as "WFMC, YUP/Get Rooted"), are not responsible for any injury, loss or damage of any kind whatsoever sustained by any person or their property while participating in events, activities or travel with Williamston Free Me- thodist Church and all related activities associated with the Williamston Free Methodist Church, including injury, loss, sickness or damage.

ASSUMPTION OF RISKS

IN CONSIDERATION OF Williamston Free Methodist Church allowing me or my child to participate in events, activities, or travel with WFMC Youth and all related activities associated with the WFMC, including participation in the Youth Ministry from January 1st, 2025 through December 31st, 2025 inclusive, and all activities related to the Youth Ministry (collectively referred to as the "Activities"), I acknowledge that I am aware of the possible Risks, Dangers and Hazards associated with participation in the Activities includingthe possible risk of severe or fatal injury to myself or others.

RELEASE OF LIABILITY and AGREEMENT

IN CONSIDERATION OF Williamston Free Methodist Church allowing me or my child to participate in the Activities, I agree on behalf of myself and/or my child:

1. TO ASSUME and ACCEPT ALL RISKS arising out of, associated with or related to my or my child's participation in the Activities.

2. TO WAIVE and RELEASE Williamston Free Methodist Church from any and all liability for any loss, damage, injury, sickness or expense that I or my child may suffer, or that my next of kin may suffer as a result of my or my child's participation in the activities due to any cause whatsoever, including Covid.

3. TO INDEMNIFY and HOLD HARMLESS Williamston Free Methodist Church from any and all liability for any damage to the personal property of, or personal injury to, any third party resulting from my or my child's participation in the activities.

4. TO INDEMNIFY and HOLD HARMLESS Williamston Free Methodist Church from any and all claims, demands, actions and costs for any loss, injury, damage or expense whatsoever that might arise out of my or my child's participation in the Activities. This includes the possibility of coming in contact with people who may unknowingly have covid. The WFMC and the WFMC youth program and its leaders will not be held liable in any capacity in any regards to covid. Covid being a virus has the potential to be carried by someone who unknowingly is carrying it. By attending outings, trips, camps and any gathering under the WFMC youth program you are acknowledging and accepting that there is always a possibility and risk of covid and that you will not hold WFMC/youth responsible if your child comes in contact, contracts or acquires any type of harm from covid or complications associated with covid.

YOUTH PARTICIPATION CONSENT

Acknowledgment of Participant: I, the undersigned Participant, understand that I am responsible to act in a safe and responsible fashion, to follow the instructions or directions of the persons in charge of the Youth Ministry, and to obey requests to comply with safety regulations as directed by the persons in charge of the Youth Ministry, including designated leaders and drivers of private or public transportation. I will be solely responsible for myself, will wear a seat-belt when available and will not disturb or distract the driver when using private or public transportation to travel to and from Youth Ministry activities. At all Youth Ministry sports events or other activities, I acknowledge that it is my responsibility to obtain and wear appropriate safety equipment. I will not endanger the safety of others or myself at any activities, outings or sports events of the Youth Ministry or when using private or public transportation for travel to and from such activities. I also understand that I may be photographed or appear in video for such purposes as WFMC deems necessary.

Acknowledgment of Parent or Guardian of Participant:

We, the undersigned Parents or Guardians of the Participant, hereby authorize and consent to the Participant's involvement in the Youth Ministry, including any use of private or public transportation deemed necessary by the persons in charge of the Youth Ministry for partici- pant travel to and from Youth Ministry activities, or to the NEAREST SUITABLE MEDICAL or HOSPITAL FACILITY in the event that emergency or other medical treatment not available at the site of a Youth Ministry activity is deemed advisable. We hereby consent to and authorize such emergency or other medical treatment of the Participant as may be deemed advisable in the event of accident, injury, or illness during the activities of the Youth Ministry. We also understand that the participant may be photographed or appear in video for such purposes as the WFMC Youth Ministry deems necessary.

ACKNOWLEDGEMENT and SIGNATURE

I UNDERSTAND THAT THIS IS A LEGAL AGREEMENT that is binding upon myself and my heirs, executors, administrators, successors and assigns. I HAVE READ AND UNDERSTAND THE TERMS OF THIS AGREEMENT and I ACKNOWLEDGE THAT by signing this agreement voluntarily, I am agreeing to abide by its terms and I am waiving certain legal rights that my child or I may have.

This Consent, Authorization and Acknowledgment shall be effective from and including January 1st, 2025 to/and including December 31st, 2025.
Signature of Parent or Guardian

Clear
If Participant is under 18 years of age
Printed Name of Parent
Date

MonthDayYear
Date
Signature of Participant*

Clear
Printed Name of Participant*
Date

MonthDayYear
Date
Should be Empty:

WFMC YUP/GET ROOTED Waiver & Parental Consent Form

Emergency Medical Release and Liability Waiver Form 2025

General Information

Emergency Information

Parent/Guardian Information

Additional Emergency Contacts

Contact #1

Contact #2

Health/Medical Information

Waiver and Consent