Engage Youth MinistryLiability Release Check One: * If partcipant is over 18 they can fill out the form themselves. If participant is under 18 a parent/legal guardian needs to fill out this form. Participant is over 18. Participant is under 18. I give my consent for photos of the participant to be posted on social media (no names will be used).. Yes No There is inherent risk when attending group events: please take that into consideration if you or your child(ren) are at higher risk of respiratory illnesses, like coronavirus. Participant Info Name of Participant * First Name Last Name Participant's Email Participant's Phone * (###) ### #### Please list an allergies: * Including food, medications, etc. (If none, please write N/A) Parent/Legal Guardian Info Parent/Legal Guardian's Cell Phone * (###) ### #### Parent/Legal Guardian Name * First Name Last Name Alternate Contact Name * First Name Last Name Alternate Contact Phone * (###) ### #### Please provide the following information: Insurance * Please choose one. Yes No Name of Insurance Participant First Name Last Name Policy Number Participant's ID Number I do hereby release, forever discharge and agree to hold harmless the Living Rock Church Ministry, personnel, workers, counselors and the directors thereof from any liability, claims or demands for personal injury, sickness, or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by the undersigned and the participant that occur while said person is participating in the above-described trip or activity including recreation and work activities. The undersigned further hereby agrees to hold harmless and indemnify said church, its directors, employees and agents for any liability sustained by said acts of said participant, including expenses incurred attendant thereto. The undersigned further consents to the administration of first aid and/or doctor’s care, or any other form of medical treatment necessitated by illness or injury that may require the same. In the event of the necessity of such care or treatment as heretofore described, the undersigned agrees to hold harmless and indemnify said church, its directors, employees, and agents from any act of malfeasance, and/or failure to act on the part of those chosen to administer medical care on behalf of the participant. Signature of Particpant (or Parent/Legal Guardian if under 18) * Please type your signature here. By checking this box I signify that I am over 18 or am the Parent/Guardian of the participant. * Yes Thank you!
