JOURNEY YOUTH LIABILITY RELEASE
By signing this you are giving permission for your son/daughter to participate in the activities and events of the Youth Ministry of Journey Church for the 2025 / 2026 school year. This gives consent for Journey Youth Leaders to be able to transport your student if needed, to seek and arrange medical emergency care, hospitalization, or surgery that may become necessary in my absence and I/we will assume financial responsibility for the same. I/We do further hereby release from any and all liability and otherwise hold harmless JOURNEY CHURCH, any and all adult sponsors and/or church staff acting in their supervisory capacity for personal injury, property or other type of loss which occurred as a result of this activity/event. The following information is accurate to the best of my knowledge
Name of Participant (Youth)
*
First Name
Last Name
Grade
*
Please Select
6
7
8
9
10
11
12
Gender:
*
Please Select
Male
Female
Medical History
*
Please Select
Diabetes
Orthopedic Issues
Asthma
Epilepsy
Cardiac Problems
Contact Lenses
Other _________________
Medical Other:
Medications Taken & when:
*
Insurance Policy # | Group # | Sub-Group
*
Family Physician & Phone Number
*
Allergies:
*
Name of Parent/Guardian Completing the Waiver
*
First Name
Last Name
Address of Participant
*
Street Address
Street Address Line 2
City
Province
Postal Code
Phone Number
*
Format: (000) 000-0000.
Anything else we should know:
Email
*
example@example.com
Name
First Name
Last Name
Submit
Should be Empty: