Yearly Youth Weekly Programming Waiver

Please complete the form below

Parent Phone *
Parent Phone
Alternative Phone
Alternative Phone
I, the parent/guardian give permission to the above-named participant(s) to participate onsite or offsite at Regina Apostolic Church, Fueled Youth Ministries weekly Friday night youth programming. *
I, the parent/guardian of the above-named participant(s), release Regina Apostolic Church, directors, staff, and leadership team from any loss, personal injury, accident, misfortune, or damage to the above named or his/her property, with the understanding that reasonable precautions shall be taken to ensure the health and safety of the above-named student. Saskatchewan Health Care or equivalent medical insurance must cover each child. *
The parents/guardians submitting this application are those having legal custody over the child. Conditions of custody, if applicable, will be fully communicated in writing to Regina Apostolic Church, Next Gen Ministries, including a photocopy of the section of any court order referring to visitation rights, where applicable. *
The signature of the parent/guardian on this application shall give the Leader(s) or staff person(s) the right to arrange for any special services or other requirements necessary for the best interest of the child and shall give the Leader(s) or staff person(s) the right to approve and obtain medical attention necessary for the student's welfare and good health including ordering injection, anesthesia, or surgery. In such a situation, attempts will be made to notify the parents/guardians as soon as possible. The parents/guardians are responsible for any additional expense that may result from such services. *
I agree to permit the reasonable use of photos and videos or other such pictures of the applicant child in promoting Regina Apostolic Church, Next Gen Ministries activities and programs. *
Signature: By entering my name in the following box, I understand this will act as my legal signature and consent in agreement with the above waiver questions. *
Signature: By entering my name in the following box, I understand this will act as my legal signature and consent in agreement with the above waiver questions.
Date *
Date