Youth Mission's Week Participation Form

Primary Contact Info (Parent/Guardian of participants under 18)

First Name

Last Name

Phone Number

Today's Date

How many participants are you registering?

One

Two

Three

I am:

Signing for myself

Signing for my child

First Name

Last Name

Birthdate

Grade

Emergency Contact

Allergies

Release of Liability
(Parental guardian signature required for children under 18 years of age.)
Before you (or your child under 18 years of age) can participate in our Mission Projects, we need to make sure that you understand and accept the risk of injury involved. Please read the following statement carefully, ask Grace Community Church staff to clarify any questions you have, and sign and fill below when you understand and agree.

I, the undersigned, do for myself or for and on behalf of my child under 18 years of age hereby affirm that:

I understand that participating in the Mission Projects involves risk of injury stemming from inherently dangerous activities such as the use of power tools, working on construction sites, transportation to and from worksites and volunteer facilities, participating in service and volunteer activities, and other activities related to participation in Youth Mission's Week. Foreseeable injuries could include but are not limited to cuts, sprains, strains, broken bones, contusions, concussions, drowning, and death. I hereby assume all risks inherent in my or my child’s participation in the Mission Projects.
I hereby release Grace Community Church and Grace Youth Group and those who work for them as employees, contractors, directors, officers, volunteers, or partners (together, the “Releasees”) from liability for personal injury, death, property damage, and expenses that I or my child suffers as a result of participating in the Mission Projects, except for personal injury or death caused by the Releasees’ recklessness or gross negligence.
I acknowledge and accept that I may be required to reimburse the Releasees for all losses, damages, and expenses that they incur as a result of my or my child’s participation in the Mission Projects, except for those incurred as a result of the Releasees’ recklessness or gross negligence.
Should it be necessary for me or my child to return home due to disciplinary action, medical reasons or otherwise, I hereby assume responsibility for all transportation costs.
For parental guardians of children under 18 years of age only:
I give permission for my child to participate in the Mission Projects.
I affirm that my child is in good health, and that my child will follow instructions of Grace Community Church staff and Grace Youth Group Leadership.
I certify that I am the parent/guardian of the minor mentioned herein, and I consent to the above statements on his/her behalf.
I acknowledge that I have read this Release of Liability and have been given reasonable opportunity to discuss this with Grace Community Church and Grace Youth Group and, if I so choose, my lawyer. I acknowledge that I fully understand the terms of this Release of Liability, and that I have signed it freely and voluntarily.

Signature

First Name

Last Name

Birthdate

Grade

Emergency Contact (Parent/Guardian)

Allergies

I understand that participating in the Mission Projects involves risk of injury stemming from inherently dangerous activities such as the use of power tools, working on construction sites, transportation to and from worksites and volunteer facilities, participating in service and volunteer activities, and other activities related to participation in Youth Mission's Week. Foreseeable injuries could include but are not limited to cuts, sprains, strains, broken bones, contusions, concussions, drowning, and death. I hereby assume all risks inherent in my or my child’s participation in the Mission Projects.
I hereby release Grace Community Church and Grace Youth Group and those who work for them as employees, contractors, directors, officers, volunteers, or partners (together, the “Releasees”) from liability for personal injury, death, property damage, and expenses that I or my child suffers as a result of participating in the Mission Projects, except for personal injury or death caused by the Releasees’ recklessness or gross negligence.
I acknowledge and accept that I may be required to reimburse the Releasees for all losses, damages, and expenses that they incur as a result of my or my child’s participation in the Mission Projects, except for those incurred as a result of the Releasees’ recklessness or gross negligence.
Should it be necessary for me or my child to return home due to disciplinary action, medical reasons or otherwise, I hereby assume responsibility for all transportation costs.
For parental guardians of children under 18 years of age only:
I give permission for my child to participate in the Mission Projects.
I affirm that my child is in good health, and that my child will follow instructions of Grace Community Church staff and Grace Youth Group Leadership.
I certify that I am the parent/guardian of the minor mentioned herein, and I consent to the above statements on his/her behalf.
I acknowledge that I have read this Release of Liability and have been given reasonable opportunity to discuss this with Grace Community Church and Grace Youth Group and, if I so choose, my lawyer. I acknowledge that I fully understand the terms of this Release of Liability, and that I have signed it freely and voluntarily.

Signature

First Name

Last Name

Birthdate

Grade

Emergency Contact (Parent/Guardian)

Allergies

I understand that participating in the Mission Projects involves risk of injury stemming from inherently dangerous activities such as the use of power tools, working on construction sites, transportation to and from worksites and volunteer facilities, participating in service and volunteer activities, and other activities related to participation in Youth Mission's Week. Foreseeable injuries could include but are not limited to cuts, sprains, strains, broken bones, contusions, concussions, drowning, and death. I hereby assume all risks inherent in my or my child’s participation in the Mission Projects.
I hereby release Grace Community Church and Grace Youth Group and those who work for them as employees, contractors, directors, officers, volunteers, or partners (together, the “Releasees”) from liability for personal injury, death, property damage, and expenses that I or my child suffers as a result of participating in the Mission Projects, except for personal injury or death caused by the Releasees’ recklessness or gross negligence.
I acknowledge and accept that I may be required to reimburse the Releasees for all losses, damages, and expenses that they incur as a result of my or my child’s participation in the Mission Projects, except for those incurred as a result of the Releasees’ recklessness or gross negligence.
Should it be necessary for me or my child to return home due to disciplinary action, medical reasons or otherwise, I hereby assume responsibility for all transportation costs.
For parental guardians of children under 18 years of age only:
I give permission for my child to participate in the Mission Projects.
I affirm that my child is in good health, and that my child will follow instructions of Grace Community Church staff and Grace Youth Group Leadership.
I certify that I am the parent/guardian of the minor mentioned herein, and I consent to the above statements on his/her behalf.
I acknowledge that I have read this Release of Liability and have been given reasonable opportunity to discuss this with Grace Community Church and Grace Youth Group and, if I so choose, my lawyer. I acknowledge that I fully understand the terms of this Release of Liability, and that I have signed it freely and voluntarily.

Signature

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