Venture Youth Waiver Form

Legacy T's Youth Waiver Form

PERMISSION/WAIVER FORM FOR YOUTH
Name of Child or Youth Participant:

First NameLast Name
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Birth date of Child:
School Name:
Academic Grade:

Functions and Activities

It is my understanding that participating in the programs and recreational and other activities of Legacy T's is a privilege. Prior to my child/youth’s participation in such activities, I acknowledge that there are certain risks associated with the activities including, by way of example, physical injury due to activity related accidents, physical injury due to transportation related accidents, illness, or even death. In addition, I acknowledge that there may be other risks inherent in these activities of which I may not be presently aware.

Release of Liability

By signing this Permission/Waiver Form, I expressly warrant that the child/youth named above is capable of withstanding the physical demands of the activities discussed above. I further release and agree to hold harmless, defend and indemnify Legacy T's and its directors, officers, employees, leaders and agents from and against any and all claims for personal injury (including loss of life) and all other losses or damages, except those caused entirely by the gross negligence or intentional conduct of Legacy T's arising from my or my child’s participation in its activities and programs.

First Aid and Emergency Medical Treatment

I recognize that there may be occasions where the child named above may be in need of first aid or medical treatment as a result of an accident, illness, or other health condition or injury. I do hereby give permission for agents of Legacy T's to seek and secure any medical attention or treatment for the child named above, including hospitalization, if in the agent’s opinion such need arises. In doing so, I agree to pay all fees and costs arising from this action to obtain medical treatment. I give permission for attending physicians(s) and other medical personnel to administer any needed medical treatment, including surgery and, again, I agree to pay for the medical treatment.

Publicity

On occasion, Legacy T's takes photographs or makes an audio or video tape recording of children and/or adults involved in church activities. Such photographs or video records may be used by staff and participants to remember the activities or participants. In addition, such photographs and audio/visual recordings may be used in Legacy T's publications or advertising materials to let others know about our company. In addition, local news organizations may hear of our activities or events, and our company may invite or allow them to photograph or record our events for news reporting on special interest features. I consent to the use of any such audio or visual record of the child named above to be used, distributed, or displayed as agents of the company see fit. This consent includes but is not limited to: photographs, videotape, and audio recordings. Furthermore, I give permission for the child to be interviewed by the news media, or for such photographs and other audio or visual records to be used by the news media.
Parent/Guardian Contact:

First NameLast Name
Parents Mobile Cell Number:

Cell PhoneSecondary Number
Parent Contact Email Address
example@example.com
Please list an Emergency Contact below:
(Must give Full Name of Contact, Relationship to Child and Mobile Number)
MEDICAL HISTORY, SPECIAL MEDICAL NEEDS OR CONCERNS, MEDICATIONS, ALLERGIES, DIETARY NEEDS, CONDITIONS AND/OR OTHER INFORMATION THAT LEADERS SHOULD KNOW ABOUT YOUR CHILD/YOUTH SHOULD BE LISTED ON REALM REGISTRATION PER INDIVIDUAL EVENT.

Parent/Guardian Authorization

I represent that I am the parent/guardian of the above child, who is under 18 years of age. I have read the above Permission/Waiver Form and am fully familiar with the contents thereof.

I give permission for the child named above to participate in the activities of Legacy T's, including any special events/activities described above. In consideration for allowing the participation of the child in the activities of Legacy T's, I hereby consent to the Permission/Waiver Form, including the Release of Liability above, on behalf of the child, and agree that this Permission/Waiver Form shall be binding upon me, my family, heirs, legal representatives, successors, and assigns.

I also understand that it is my responsibility to see that the information on this form is updated when there are any changes in my child’s/youth’s medical status, etc.

Young Person’s Agreement

I agree to participate in the functions and activities of Legacy T's, to cooperate with the leaders and other young people and to conduct myself resposibiliy. I promise to respect other persons, and property. I understand that my continued participation depends on my support of this agreement.
By signing I agree I have read and filled out all information on this waiver to the best of my ability.
Should be Empty:

Legacy T's Youth Waiver Form