Liability Release Form - Youth Activities
Liability Release Form (Youth Activities)
Child's Information:
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Name: ______________________________
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Date of Birth: ____/____/____
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Address: ________________________________________________________
Parent/Guardian Information:
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Name: ______________________________
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Phone:
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(H) ______________________________
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(W) ______________________________
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(M) ______________________________
Emergency Contact:
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Name: ______________________________
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Phone:
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(H) ______________________________
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(W) ______________________________
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(M) ______________________________
Activity Details:
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Name of Activity: ______________________________
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Date(s): ____/____/____ to ____/____/____
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Location: ______________________________
Medical Information:
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Doctor's Name: ______________________________
Phone: ______________________________ -
Any medical conditions or allergies:
______________________________________________
______________________________________________
Consent and Release:
I, the undersigned parent/guardian of the above-named child:
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Give permission for my child to participate in the above-named activity.
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Understand and acknowledge that this activity involves risks.
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Authorise Generocity Church to obtain any necessary medical treatment for my child in case of injury or illness, and agree to pay for any such medical treatment.
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Release Generocity Church, its staff, and volunteers from any liability related to my child's participation in this activity.
Photo/Video Release:
□ I give permission for Generocity Church to use photos/videos of my child for promotional purposes.
□ I do not give permission for photos/videos of my child to be used.
Signature of Parent/Guardian: ______________________________________________
Date: ____/____/____