Scribd
Upload
70 views1 page

Socalmmr2012 Consent Form

This document is an emergency contact and liability waiver form for a youth music ministry retreat hosted by CFC Youth SoCal in June 2012. It requests the participant's name and emergency contact information. The parent or guardian signs to consent to the participant's attendance, and to waive any liability of the organizers for issues arising from participation in retreat activities. It also certifies that the provided information is accurate.

Uploaded by

ohjulienne
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
70 views1 page

Socalmmr2012 Consent Form

This document is an emergency contact and liability waiver form for a youth music ministry retreat hosted by CFC Youth SoCal in June 2012. It requests the participant's name and emergency contact information. The parent or guardian signs to consent to the participant's attendance, and to waive any liability of the organizers for issues arising from participation in retreat activities. It also certifies that the provided information is accurate.

Uploaded by

ohjulienne
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 1

CFC

YOUTH SOCAL MUSIC MINISTRY RETREAT 2012

PARTICIPANT NAME: __________________________________________ EMERGENCY INFORMATION


Name:______________________________Relationship:________________________

Phone #:______________________Cell/Pager #:______________________________ Family Doctor:_________________ Phone/Pager #:___________________________ Hospital Name:______________________Address:___________________________ Medications Currently Taken:____________________________________________ Medications/Items Allergic to:____________________________________________ Physical Activity Restrictions:_____________________________________________

CONSENT & RELEASE WAIVER FORM


I am the undersigned parent and/or guardian of the child whose name appears below, hereinafter known as Participant, and I hereby give my consent for the Participant to attend the CFC-YOUTH Socal Music Ministry Retreat, in Castaic, California on June 15-16, 2012. CFC-YOUTH and its Ministries, organizers and leaders are, therefore, fully absolved and released from any and all responsibility and/or liability that may directly or indirectly arise from or be incidental to the Participants attendance, participation and involvement in any and all activities within the scope of the pre-conference. I understand and agree that I hold CFC-YOUTH, its Ministries, organizers and leaders free and harmless from any liability, costs or damages to any person/s and/or property caused by, arising out of, or incidental to, the Participants attendance, participation and involvement in this pre- conference. By signing below, I certify that all the above information is true and correct to the best of my knowledge, and I fully and voluntarily agree to the above consent and waiver.

__________________________________ ____________________________________
Signature of Participant

Signature of Parent/Guardian

__________________________________ ____________________________________ Date Date

You might also like