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True North Church

A church with a heart for the unchurched.

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Consent/Release Form for Youth Activities for True North Church

True North Church > Consent/Release Form for Youth Activities for True North Church
Consent/Release Form for Youth Activities for True North Church
Name of student/participant *
Name of student/participant
First Name
Last Name
Name of parent(s) or legal guardian(s) *
Name of parent(s) or legal guardian(s)
First Name
Last Name
Is True North Church or their representative authorized to approve medical treatment? *
Is the student/participant covered by personal/family medical insurance? *
If there is no insurer, please fill in with “N/A”
If there is no insurer, please fill in with “N/A”
Please read the paragraph below and answer. *
I/We acknowledge that participation in activities sponsored by True North Church’s Tribe Youth Group may involve risk to the Participant (and to the Participant’s parents or guardians, if the participant is a minor), and may result in various types in injury including, but not limited to, the following: sickness, bodily injury, death, emotional injury, personal injury, property damage and financial damage. In consideration for the opportunity to participate in activities sponsored by True North Church’s Tribe Youth Group, the Participant, or parents/guardians if the Participant is a minor, acknowledges and accepts the risks of injury associated with participation in and transportation to and from Tribe Youth Group activities. The participant (or parent/guardian) accepts personal financial responsibility for any injury or loss sustained during the activity or during the transportation to and from the activity, as well as for any medical treatment rendered to the participant that is authorized by the Sponsor or its agents, employees, volunteers, or any other representatives (collectively referred to hereinafter as the “Activity Sponsor”). Further, the Participant (or parent/guardian) releases and promises to indemnify, defend, and hold harmless the Activity Sponsor for any injury arising directly or indirectly out of the described Activity or transportation to and from the Activity, whether such injury arises out of the negligence of the Activity Sponsor, the Participant, or otherwise. If a dispute over the agreement or any claim for damages arises, the Participant (or parent/guardian) agrees to resolve the matter through a mutually acceptable alternative dispute resolution process. If the Participant (or parent/guardian) and the Activity Sponsor cannot agree upon such a process, the dispute will be submitted to a three-member arbitration panel for resolution pursuant to the rules of the American Arbitration Association.

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