FIRST FREE YOUTH - 2022-2023 WAIVER & INFORMATION FORM

Please contact Katy Fruit at katyfruit@firstfree.org for any questions or assistance.

2022-2023 FIRST FREE YOUTH - RELEASE WAIVER

Parents or Legal Guardians of minor youth should fill out this form and click submit. One form should be submitted for each minor youth.

GENERAL YOUTH INFORMATION:

Name

Date of Birth:

Gender:

Male Female

Grade Level (2022/2023):

6th (if not attending Awana) 7th 8th 9th 10th 11th 12th

School attending (2022/2023):

Best phone number:

Best email:

Address:

Church Service normally attended:

Sunday 1st Sunday 2nd None Serve/volunteers during church

Youth ALLERGY AND MEDICAL INFORMATION

This information provided will be treated as strictly confidential. Information on allergies, medical diagnoses and medications will be used solely to help provide a safe environment for youth.

Please list known allergies: (for example - dairy products, peanuts, etc.)

Please list known medical diagnoses: (for example - history of cardiac abnormalities, seizures, asthma, gastrointestinal issues, etc.)

Please list all prescribed medications:

PARENT/LEGAL GUARDIAN INFORMATION:

Must list one, may list up to two.

(1) Parent/Legal Guardian Name:

Is the parent/legal guardian address the same as the student?

Yes, address is the same as student No, address is different from student

Address:

Best Phone:

Email:

This address will receive a confirmation email

(2) Parent/Legal Guardian Name:

Is the parent/legal guardian address the same as the student? Yes, address is the same as student No, address is different from student

Address:

Best Phone:

Email:

This address will receive a confirmation email

I, the undersigned, give permission for the minor under my guardianship, to voluntarily participate in youth-group-related games and/or activities in conjunction with First Free Church’s youth group program for the 2022-2023 school year. In consideration to being permitted to participate in these games and/or activities beginning September 1st, 2022 through August 31st, 2023, I, the undersigned, fully recognizing the dangers and hazards inherit in any games and/or activities as well as any related transportation, including personal injury, property damage, or wrongful death, as well as the unknown dangers and hazards which may arise in the course of my minor’s participation in First Free Church’s youth group program for the 2022/2023 school year, do hereby voluntarily:

Agree, for the minor under my guardianship, to defend, hold harmless, indemnify, release and forever discharge, to the broadest extent allowed by law, First Free Church, its trustees, employees, agents, insurers, successors, assigns, from and against any and all claims, demands, actions, or causes of action on account of any damage to real or personal property or any personal injury or death that may result from their participation in First Free Church’s youth group program for the 2022/2023 school year. I understand youth may be photographed or recorded during program/event activities. These pictures/videos may be used for presentation during programming/events, in our promotional materials, on First Free Church's website and/or social media outlets. I give my permission for my child to be photographed and recorded.

I have read this release, I understand it fully, I understand that it is legally binding, and I understand that, among other things, I am agreeing to indemnify First Free Church for injuries, damages, or losses I may cause and giving up rights to sue First Free Church for injuries, damages, or losses I may incur.

Name (Parent/Legal Guardian) - by entering my name here, I am signifying understanding and acceptance of the Release Waiver:

Date

FIRST FREE YOUTH - 2022-2023 WAIVER & INFORMATION FORM

Description

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