2025 Middle School YFC Camp: Health and Consent Form (July 25-29)

Health and Consent Form for Summer Camp
2025 YFC Middle School Camp: Health and Consent Form.
2025 Middle School YFC Camp (July 25-29, 2025)

We at YFC Camp would like to provide the best camping experience for all our participants. Thus, it is important that we make sure to be aware of each and every health concern of our participants during the camp by having the information requested in this form. We guarantee that the information acquired here will not be shared with any third party.
Today's Date *

MonthDayYear
Date
Name of Participant*

First NameLast Name
Date of Birth *

MonthDayYear
Date
Gender (for housing and rooming considerations only)*

MaleFemale
Which YFC Chapter are you traveling with *
Name of Parent/Guardian*

First NameLast Name
Phone Number (Mobile)*
Please enter a valid phone number.
Phone Number (Secondary)
Please enter a valid phone number.
Email*
example@example.com
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
In Case of Emergency: other than above Parent/ Guardian
Contact Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Secondary Number
Please enter a valid phone number.

C O N S E N T

CONSENT AND RELEASE OF LIABILITY
Permission to participate - Recognize accidents may happen when doing fun stuff and accept risks – Choose to come healthy -
Hold YFC harmless - Consent to emergency medical treatment and costs – Media release - Behavior agreement for safety

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.
Signature of Parent*

Powered by Jotform SignClear
Name of Parent Signatory*

First NameLast Name
Participant Name

First NameLast Name
Date Signed*

MonthDayYear
Date
Almost Done! Please press next to the final section!

GUEST CONSENT RELEASE FORM FOR OUTSIDE GROUPS USING YOUNG LIFE CAMP YL-6009
Youth for Christ (July 25-29, 2025)

Your Camp Dates: July 25-29, 2025
Name of participant *

First NameMiddle InitialLast Name
Is the participant under the age of 18?*

YesNo
Birthdate*

MonthDayYear
Date
Age*
Sex
First Emergency Contact *

First NameLast Name
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Business Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Business Phone Number
Please enter a valid phone number.
Any allergies or other medical needs?
Name of Physician

First NameLast Name
Physician Phone #
Please enter a valid phone number.
Physician Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
I have had a physical within the last 24 months

YesNo
Medical Insurance Company
Policy Number
Insurance Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
INDEMNITY AND CONTRACT AGREEMENT

I will not hold or attempt to hold Young Life liable for any loss, damage or injury to person or property caused by any act or neglect of other persons on or about the Property, or caused in any manner other than the willful or negligent act of Young Life, its agents and employees, and will indemnify and hold Young Life harmless from any liability for damages or claims against Young Life arising out of or in any way related to any such loss, damage or injury.

I release Young Life, including its trustees, employees and agents, from my physical injury, including death, or illness while at the Property. I will assume the risk associated therewith, whether known or unknown to me at this time. This release is also intended to include all claims of my family, estate, heirs, personal representatives or assigns.

AUTHORIZATION FOR TREATMENT

I hereby give permission to the medical personnel selected by the camp director to secure and administer treatment and to maintain and/or release any medical records necessary for insurance purposes as outlined under the HIPAA regulation, and to provide or arrange necessary related transportation for the above named person.
To obtain a copy of Young Life’s Notice of Privacy Practices, log on to www.younglife.org or call (719) 867-3600.
I verify that I am or my child is in good health and am capable of participating in strenuous activities, and when necessary, will tailor my activities to those within the bounds of my physical health.
In Colorado, campers will participate in rigorous activities at 9,000 to 14,000 feet. I recognize that any medical treatment and/or medical transportation that is provided to me or my child while attending a Young Life camp will be paid for by my medical insurance company.
Canada: Malibu Club/Beyond Malibu: I agree that any complaint, demand, dispute, claim involving bodily injury including death and/or personal injury or cause of action arising out of or in any way related to Young Lie’s Malibu Club or Beyond Malibu, including any activity, event, medical treatment, and/or transportation will be governed by the laws and jurisdiction of the Canadian Province where the event or incident occurred.

COVID-19

I recognize that a national emergency was declared because of the COVID-19 outbreak and that different states and/or counties/cities may be in various states of emergency. I recognize that even if Young Life has taken reasonable actions in light of COVID-19 and other coronaviruses, there is no guarantee that me or my child will not contract/transmit COVID-19 or other infectious or contagious illnesses or diseases while participating in activities and events at the Young Life property/camp, or traveling to and from, Young Life’s camp property and I release Young Life in the event of such an occurrence.
The Center for Disease Control ( CDC) has identified that certain individuals are at Higher Risk for Severe Illness if they become ill with COVID-19. This includes those who have chronic lung disease, moderate/severe asthma, a serious heart condition, are immunocompromised, or have severe obesity, diabetes, or chronic kidney/liver disease or who are over the age of 65. Based on the CDC’s High-Risk criteria, you have determined if you want to participate in this event or if you want your child to participate in this event.

WAIVER AND RELEASE

If I am under the age of 18, or under the age of 19 if attending Malibu Club or Beyond Malibu, my parent or guardian, by signing below, also
consent to my release and he or she agrees that this release shall be binding upon him or her as my parent or guardian as to me and my estate,
heirs, personal representatives and assigns. My parent or guardian also promises, by signing below to defend, indemnify and hold Young Life
harmless from any claim asserted by me against Young Life, including its trustees, employees and agents, if I should repudiate this release after
obtaining adulthood.
Signature of Participant/ Legal guardian or Parent*

Powered by Jotform SignClear
Name of Signer

First NameLast Name
Date Signed*

MonthDayYear
Date
Should be Empty:

Health and Consent Form for Summer Camp

Almost Done! Please press next to the final section!

GUEST CONSENT RELEASE FORM FOR OUTSIDE GROUPS USING YOUNG LIFE CAMP YL-6009