Revolution YTH Permission Form (Jan. 1, 2025-Jan. 1, 2026)

Student Information

Student Name*

First NameLast Name

Birth Date*

MonthDayYear

Sex*

MaleFemale

Grade*

School*

Adult Shirt Size*

Preferred Roommates for Overnight trips?

Be as descriptive as needed to help understand.

Student Cell Number*

Area CodePhone Number

Student Email*

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Medication Information - List Times & Dosage.

Be as descriptive as needed to help understand.

Parent/Guardian Information

Name*

First NameLast Name

Cell Number*

Area CodePhone Number

Parent/Guardian Email*

Preferred Method of Contact?*

Is Sponsor Authorized to Approve Medical Treatment?*

YesNo

Parent Permission Slip & Liability Waiver:

We, the parent or guardian do hereby give our permission for this person to be transported by any legal drivers for New Creation World Outreach Church. In the event of accident, sickness or injury to said person our approval is granted for the chaperone(s) to engage a Medical Doctor, hospital or clinic etc. for any services needed. Furthermore, in the event of an accident, injury, sickness, or fatality to said person occurring during transportation to/from or while participating in a New Creation World Outreach Church activity, we will not hold New Creation World Outreach Church, Pastor, Leaders, Members or its workers or chaperones/driver responsible or accountable and hereby accept any and all responsibility for any of these incidents. We voluntarily assume on his/her behalf any such risks.

Informed Consent and Acknowledgement:

I acknowledge that participation in activities from January 1, 2025 through January 1, 2026 involves risk to the Participant (and to Participant’s parents or guardians, if Participant is a minor), and may result in various types of injury including, but not limited to, the following: sickness, bodily injury, death, emotional injury, personal injury, property damage and financial damage.

In consideration for the opportunity to participate in activities, the Participant (or parent/guardian if Participant is a minor) acknowledges and accepts the risks of injury associated with participation and transportation. The Participant (or parent/guardian) accepts personal financial responsibility for any injury or other loss sustained during activities and transportation, as well as for any medical treatment rendered to the Participant that is authorized by the Sponsor or its agents, employees, volunteers, or any other representatives. Further, the Participant (or parent/guardian) releases and promises to indemnify, defend, and hold harmless the Sponsor for any injury arising directly or indirectly out of the described activities or transportation, whether such injury arises out of the negligence of the Sponsor, the Participant, or otherwise.

If a dispute over this agreement or any claim for damages arises, the Participant (or parent/guardian) agrees to resolve the matter through a mutually acceptable alternative dispute resolution process. If the Participant (or parent/guardian) and the Sponsor cannot agree upon such a process, the dispute will be submitted to a three-member arbitration panel for resolution pursuant to the rules of the American Arbitration Association.

Parent/Guardian:

I give permission for the Participant to attend any event from January 1, 2025 through January 1, 2026 in North Mankato, Mankato, and any other location and do not hold New Creation World Outreach Church liable for any injury that may occur. I have read, understand, and agree to the student terms. I grant permission for my student to ride in a vehicle, be videotaped, and photographed at any event from January 1, 2025 through January 1, 2026 for promotional reasons only. I agree to go over the student terms with my child and encourage respectful behavior.

Is Student Covered By Personal/Family Medical Insurance?*

YesNo

If Yes, Name of Insurer:

Policy or Group Number:

Student Terms:

1. No males in females rooms, no females in males rooms (includes siblings).
2. No alcohol, drugs, tobacco, vapes, weapons (of any kind), or explicit content (whether physical or on an electronic device).
3. No 1-on-1 time with the opposite sex in leader unsupervised areas.
4. For Summer Camp: no electronic devices once we get to camp (except designated times or granted approval).
5. Have a positive attitude and conduct yourself in a responsible and respective manner to all leaders and peers. This includes a strict no-bullying policy.
6. If you become overly active because of certain food or drinks or smell strongly because of perfume/cologne, they can be taken away in the event of a complaint.
7. Turn in medications and bring a list of times/dosage for our records. (Unauthorized medication will be taken away and parents called).
8. Students should check-in with leaders and inform them of your whereabouts at designated times (mostly in large crowd gatherings).
9. Students must wear appropriate clothing and swimwear (Tankini - no midriff showing, One-Piece, or Shorts & Shirt/Tank Top) at all times.
10. Students must pay in-full before the deadline, be on time, participate in all events (unless granted permission) and obey curfew. It is your responsibility to communicate to a leader if you cannot meet any of these expectations.

Student: I have read, understand, and agree to the terms. I understand that if I do not follow the rules I may be sent home at my parent/guardian’s expense. It is church policy that any student who displays unacceptable behavior during the event and refuses to be redirected, his/her parents will be called and will be required to come and pick him/her up, even at a long distance. Please help make all activities fun for everyone!

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

Type your Parent/Guardian Name to Agree*