2026 Christ In Youth Medical Release and Consent Form

2026 Christ In Youth Medical Release and Consent Form

NB: Any dietary requirements or need for mobility support must be submitted to CIY two weeks before the event.
Church/Group you are attending with
Group Leader's Name

First NameLast Name
Group Leader's Email
example@example.com
Group Leader's Phone Number
Please check which one best describes your attendance:

YouthVolunteer LeaderGroup Leader
Name of Participant

First NameLast Name
Gender
Date of Birth

MonthDayYear
Date
Address
Postcode
Phone Number
Medical Information

Please outline ALL information required to best support you or your young person
Known medical conditions:
Medications currently taking and frequency required:
Any known allergies and reactions:
Any other relevant information:
Emergency Contact Details
Name (NB - if participant is under 18 years, this should be the parent/legal guardian):

First NameLast Name
Relationship
Phone Number
If address is different from above, please note:
Person to notify if above person can't be reached:

First NameLast Name
Relationship
Phone Number
Onsite Support
Dietary Requirements

YesNo
Please specify dietary requirements:
Any mobility support required? Eg. wheelchair use or accessibility support:

YesNo
Details:
If you answer yes to either of these please submit this form to CIY two weeks BEFORE the event so we can facilitate your requests and best support, you.
I, the participant or for those under 18 the parent or legal guardian of the participant listed on this form, certify that he/she has my full approval to participate in this Christ in Youth programme and is under the care and guardianship of the youth leaders and Church/Group that has brought my child/ren to this camp. The individual identified on this form understands that all participants are required to abide by the programme rules and be directly responsible to the Christ in Youth Programme Director. The Christ in Youth Programme Director assumes responsibility for discipline at the Programme and, if necessary, may, because of misconduct or disobedience, require a participant to leave. In such instance, I will assume full responsibility for collecting and returning the participant home.

Further, I authorise the youth leader of the Church/Group, or any Christ in Youth staff/volunteer member to take the participant to a doctor or hospital if required. I authorise the administration of first aid for minor incidents that warrant first aid from a qualified leader. I hereby authorise medical treatment, including but not limited to emergency surgery or medical treatment, and I hereby assume financial responsibility for all expenses incurred for such treatment and, if necessary, all expenses to return the participant home.

Further, I hereby assume all risk of personal injury, sickness, death, damage and expense as a result of the participation in this Christ in Youth Programme. I hereby release and agree to hold harmless and indemnify the Covered Parties, for any liability and/or expense sustained as the result of negligent, wilful or intentional acts of the participant, including damages to the Programme facility and/or keys or equipment not returned. I agree to pay for any damage done to any facility or Christ in Youth property by the participant.

I give consent that my data can be used internally within CIY and am happy to receive information and updates regarding CIY and its opportunities.
I give permission for my (or my child's) photographs/images to be taken and used by Christ In Youth in all forms of media; commercial and non-commercial.

YesNo
Participant under 18 years of age

I hereby certify that I have carefully read the foregoing and acknowledge that I understand and agree to all of the above terms and conditions.
Signature of parent/legal guardian for those under 18.

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Name of Parent/Legal Guardian

First NameLast Name
Email
example@example.com
Date

MonthDayYear
Date
Participant over 18 years of age

I hereby certify that I have carefully read the foregoing and acknowledge that I understand and agree to all of the above terms and conditions.
Signature

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Name

First NameLast Name
Date

MonthDayYear
Date
Should be Empty:

2026 Christ In Youth Medical Release and Consent Form

Medical Information

Emergency Contact Details

Onsite Support

If you answer yes to either of these please submit this form to CIY two weeks BEFORE the event so we can facilitate your requests and best support, you.

Participant under 18 years of age

Participant over 18 years of age