Stonehouse Youthgroup

Student 1 Name

First NameLast Name

Birthday

Date

School grade

Gender

MaleFemale

Student E-mail

Optional

Student Phone Number

Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Student 2 Name

First NameLast Name

Birthday

Date

School grade

Gender

MaleFemale

Student E-mail

Optional

Student Phone Number

Name parent / guardian

First NameLast Name

Phone Number

Email

example@example.com

Name parent / guardian # 2 (optional)

First NameLast Name

Phone Number

Allergies:

What, if any, medications will your child regularly bring to a youth event?

Emergency contact

First NameLast Name

Phone number

I consent to my child’s photo to be taken, understanding it could be used in Stonehouse promotion and social media.

yesno

I consent to receive Stonehouse Youth related emails.

yesno

From time to time, Stonehouse Youth will plan activities away from the CMS property. By completing this form, you give permission for your child to travel in a motor vehicle driven by a Stonehouse-approved driver to the designated event location. All Stonehouse-approved drivers must have at least two years of driving experience, hold a valid driver’s license, and maintain current registration and insurance. While traveling, your child is required to observe all applicable motor vehicle laws and follow the instructions of the driver or other supervising adults.

Although every effort is made to ensure the safety and well-being of participants, certain sports and activities involve risks of injury. By signing this waiver, you acknowledge these risks and accept that participation may expose your child to potential injury. Stonehouse Youth Ministry is committed to minimizing unnecessary risks and will take reasonable precautions to safeguard all students.

In the case of accident, illness, or other incapacity of a student, a Stonehouse youth leader will contact the student's parent or guardian to determine the best course of action and/or for approval before providing transportation to a hospital.

I have read and understand the risks related to Stonehouse Youth activities and off-site events, including the transportation required for them. I agree to not hold Stonehouse Covenant Church, its leaders, employees, and volunteers liable for damages, losses, diseases, or injuries incurred by the student named in this form.

yesno

Name of parent/guardian completing this form

First NameLast Name

Date

Please verify that you are human*

This waiver form is effective from date of signing to September, 2026. This information will be used for Stonehouse purposes only and is kept strictly confidential.

Stonehouse Annual Youth Waiver 2025/26

Parent/guardian information

Medical information

Emergency Contact

Parental consent

Off-site consent