Participation Waiver

Ferry Memorial Reformed Church Activity Participation Agreement
For ferry youth group - Date: Sept 2022- May 2023
Including transportation to/from events
Participant Information (To be completed by participant/guardian)

* Indicates required field

Name of Parent/Guardian: *

Phone Number *

Email *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Emergency Contact *

Relationship *

Phone Number *

1st Child *

Grade *

List of Allergies or Medical Conditions: *

2nd Child *

Grade *

List of Allergies or Medical Conditions: *

3rd Child *

Grade *

List of Allergies or Medical Conditions: *

4th Child *

Grade *

List of Allergies or Medical Conditions: *

I agree that photographs that include my child(ren) may be used internally by the church, on church website and Facebook page. *

Yes No

Is sponsor (Ferry Church) authorized to approve medical treatment? *

Yes No

Is participant covered by personal/family medical insurance? *

Yes No

If yes, name of insurer*:______________________________________________

Policy or group number*:_____________________________________________

Participation Agreement:
I acknowledge that participation in the activity described above involves risk to the Participant (and to Participant’s parents or guardians, if Participant is a minor), and may result in various types of 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 the activity described above (the “Activity”), the Participant (or parent/ guardian, if Participant is a minor) acknowledges and accepts the risks of injury associated with participation in and transportation to and from the Activity. The Participant (or parent/guardian) accepts personal financial responsibility for any injury or other loss sustained during the Activity or during 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 this 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.

Signature *

Date *

Submit

Ferry Memorial Reformed Church Activity Participation AgreementFor ferry youth group - Date: Sept 2022- May 2023Including transportation to/from eventsParticipant Information (To be completed by participant/guardian)

Ferry Memorial Reformed Church Activity Participation Agreement
For ferry youth group - Date: Sept 2022- May 2023
Including transportation to/from events
Participant Information (To be completed by participant/guardian)