HEATWAVE Registration & Consent

Please complete and submit payment through YFC website

Health and Parental Permissions

PLEASE INDICATE MEDICATION THAT CAN BE TAKEN WITHOUT SPECIAL PERMISSION

This health history is correct as far as know, and the student listed has permission to engage in all prescribed camp activities, except as noted by me. I give permission for the group leader that takes my child to this scheduled event to provide ongoing health care and to select local medical personnel to order tests and treatment as needed for the student listed. In the event that I cannot be reached in an emergency, I hereby give permissionto the physician selected by the group leader to hospitalize, secure proper treatment for, and to order injection and/or anesthesia and/or surgery for the student listed.

HEALTH INSURANCE POLICY INFORMATION

1. RELEASE OF LIABILITY - “I give my permission to participate in YFC activities. I understand accidents can happen when doing fun activities and accept the risks. I or my child agree to come to YFC activities healthy.”
I understand that the opportunity to participate in YOUTH FOR CHRIST/USA, INC., et al (“YFC”) activities is a privilege. I am signing this Release of Liability form on behalf of myself or my minor child. I understand that my child or I may participate in any number of physical activities some of which include, but are not limited to, recreational activities and games and events. I understand that there are certain risks of physical injury or illness associated with these activities. In addition, I understand that there may be other risks associated with activities of which I may not be presently aware.
By signing this Release, I expressly assume these risks for myself or my minor my child, whether they are known or unknown to me at this time and certify that I or my child is healthy and fit to participate in all YFC activities. I release YOUTH FOR CHRIST/USA, INC., including its affiliated chapters, affiliates, and their officers, directors, volunteers, employees, contractors and agents, from any claim that I or my child may have now or in the future against them for any accidental physical or other personal injury, loss of personal property, illness or death caused by infectious and/or contagious diseases or sickness while at camp or other YFC activities, or during YFC travel to and from camp or other YFC activities, and any medical responses to the same, as well as any other claims arising from participation in YOUTH FOR CHRIST/USA, INC. et al activities. This release of liability shall cover (without limitation) all claims for negligence and breach of fiduciary duty asserted by my child, myself or any person made on their behalf. This Release specifically covers claims caused in whole or in part by any U.S. national health crisis, epidemic, pandemic, or similar widespread outbreak of disease whether or not such is formally declared by the U.S. government, the Center for Disease Control or the World Health Organization. YFC reserves the right to follow recommended CDC guidelines related to such pandemic, outbreak or disease and as such may choose at any time to send a participant home if presenting signs of sickness.
2. INDEMNIFICATION – “I agree to hold YFC harmless.”
I hereby agree to defend, indemnify and hold YOUTH FOR CHRIST/USA, INC., including its chapter affiliates, their directors, volunteers, employees, contractors and agents, harmless from any liability asserted by me or my child subsequent to his or her 18th birthday, including reasonable attorney's fees and costs.
3. AUTHORIZATION FOR MEDICAL TREATMENT - “If an accident happens and if I cannot be reasonably reached, I give permission for emergency medical treatment and promise to cover medical costs if treatment is needed.”
I understand it may be necessary to have a medical consent form present for medical professionals in the unlikely event of an injury or condition requiring medical treatment of me or my child. This form gives YFC and its personnel the permission to take me or my child to the nearest, capable medical facility and have any necessary emergency treatment administered.
IF PARTICIPANT IS A MINOR: IN CASE OF EMERGENCY, I UNDERSTAND THAT EFFORTS WILL BE MADE TO CONTACT ME; HOWEVER, IF I CANNOT BE REACHED, I HEREBY GIVE YOUTH FOR CHRIST/USA, INC. AND ITS REPRESENTATIVES THE PERMISSION TO ACT ON MY BEHALF IN SEEKING EMERGENCY MEDICAL TREATMENT FOR MY CHILD IN THE EVENT THAT SUCH TREATMENT IS DEEMED NECESSARY OR ADVISABLE FOR MY CHILD'S HEALTH, SAFETY AND WELFARE. I GIVE PERMISSION TO THOSE ADMINISTERING MEDICAL TREATMENT TO DO SO, USING THE MEASURES DEEMED NECESSARY. I RELEASE YOUTH FOR CHRIST/USA, INC., ITS REPRESENTATIVES, AND ALL MEDICAL PROVIDERS FROM LIABILITY IN ACTING IN THIS REGARD AND RENDERING SUCH MEDICAL TREATMENT. I WILL BE FULLY RESPONSIBLE FOR ALL SUCH MEDICAL EXPENSES.
IF PARTICIPANT IS 18 OR OVER: IN CASE OF EMERGENCY, AND AM UNABLE TO REPRESENT MYSELF, I HEREBY GIVE YOUTH FOR CHRIST/USA, INC. AND ITS REPRESENTATIVES THE PERMISSION TO ACT ON MY BEHALF IN SEEKING EMERGENCY MEDICAL TREATMENT FOR MY PERSON IN THE EVENT THAT SUCH TREATMENT IS DEEMED NECESSARY OR ADVISABLE FOR MY HEALTH, SAFETY AND WELFARE. I GIVE PERMISSION TO THOSE ADMINISTERING MEDICAL TREATMENT TO DO SO, USING THE MEASURES DEEMED NECESSARY. I RELEASE YOUTH FOR CHRIST/USA, INC., ITS REPRESENTATIVES, AND ALL MEDICAL PROVIDERS FROM LIABILITY IN ACTING IN THIS REGARD AND RENDERING SUCH MEDICAL TREATMENT. I WILL BE FULLY RESPONSIBLE FOR ALL SUCH MEDICAL EXPENSES.
4. MEDIA RELEASE - “YFC can use pictures and other media of me or my child participating in YFC activities for promotional purposes.
I hereby grant permission to YOUTH FOR CHRIST/USA, INC. the right to use, reproduce, and/or distribute any photographs, film, video and sound recordings of me and my child, without compensation or approval rights, for use in materials created for purposes of promoting the future activities of YOUTH FOR CHRIST/USA, INC.
5. BEHAVIORAL AGREEMENT – “YFC hates sending participants home, but sometimes they have to. I recognize that.”
I understand that illegal, immoral activity, or behavioral issues may result in the named participant being sent home at the expense of the parent/guardian. Activities would include but are not limited to: reasonable belief of possession and/or use of drugs, alcohol, weapons; sexually aggressive and/or inappropriate behavior; stealing; fighting; etc. YFC leaders will make reasonable effort to contact the parent/guardian to make arrangements before a participant is sent home.

I have read the above waivers/releases and understand what I have read.
I represent that I am the participant named below (if 18 or over) or the legal parent/guardian of the child named below, who is under 18 years of age. In consideration for allowing my child to participate in this activity and ongoing YFC activities, I hereby consent to the foregoing on behalf of my child and agree that this release shall be binding upon me, my child, our heirs, legal representatives and assigns.

I will cooperate with ALL Campus Life staff for the duration of the trip/event.

I will report to designated group meeting locations ON TIME.

I will refrain from use of alcohol, illegal drugs and tobacco*

I will refrain from the appearance of a sexual activity or sexually related acts.

I will not bring any type of firecracker or any type of instrument that could be considered a weapon. This includes guns ofany kind, including BB guns and toy guns. It also includes pocketknives, pen knives, camping knives or tools, switchblades,cutters, sling shots, etc. If I have any questions regarding this, I will ask before the event.

I will not yell, throw things, etc., from anywhere at the hotel or in the convention center.

I will wear clothing deemed appropriate by Mason Dixon Campus Life. This means avoiding any excessively revealingclothing. Please do not wear any clothing that promotes or alludes to drug, alcohol, or sexually related messages. If necessary, a t-shirt will be provided to be worn over, or in place of, any offensive articles of clothing. **Girls Bathing suits:A modest, one-piece bathing suit or 2-piece tankini is preferred. If a very immodest bikini is worn you may be asked tochange or wear something over it. Guys: No Speedos, please wear regular swimming trunks. (These guidelines applyeven if other groups are less aware of the issue of modesty.)

I will do my best to avoid using vulgar or abusive language and/or words that misuse God’s name.

I further understand that stealing, damaging the property of others, lying, fighting, bullying and/or the harassment of others are grounds for my immediate dismissal or removal from the event.

I will not be disrespectful to the speakers or those seated around me by talking, passing notes, or being distracting.

I will always remain within approved areas and avoid areas designated as off limits. Students should not be on anyfloor of the hotel other than the floor their room is on, the lobby, the swimming pool/game room, or any room we use for sessions.

For my own safety and the safety of others I will adhere to the “buddy system” and go nowhere alone.

For the benefit of the leaders responsible for me, I will ALWAYS notify a staff member of any changes in my plans/activities so that the leader will have an idea of my location in the event of an emergency.

I understand that the use of personal electronics such as video games, MP3 players, and cell phones is greatly restricted,and in some cases disallowed. I may be required to turn my cell phone OFF during all conference sessions and from 11 p.m.to 7 a.m. each day. I understand that a 24-hour emergency number to a Campus Life staff member has been provided to my parent or guardian in the event that I need to be reached in an emergency during these hours.

Curfew times will vary with each day’s program schedule.I will abide by the designated curfew times and be in bed andquiet after “lights out.”

Students will not be permitted to sleep on the balcony or travel from room to room by climbing through the balcony railings.

I will not get any piercings or tattoos at this event.

My Student and I have read, and will abide by the Student Guidelines & Expectations.