COG Youth - Permission Form 2024/2025

*We ask that a PARENT/Guardian fills out a waiver form each year for your children attending Moosejaw Church of God Youth Group! Thank you*

By completing this form you allow your child to participate in ANY ACTIVITY in the COG Youth Group. This may include holiday activities, bus trips, travel by car (if necessary), interaction with the public, bonfires, water activities and off-site activities but DOES NOT include camps.

Your name *

Email address *

Phone number *

Parent #2 (optional)

Name, Email & Phone Number

Please list the name(s), birthdate(s), and grade(s), and school(s) of your child(ren). *

ie. James Jones, Mar 5/2010, Gr. 8, cornerstone
Sally Jones, June 12, 2008, Gr. 10, Central

Medical note *

Please write down any medical information your child(ren) have
ie. James Jones - allergic to wheat, ADHD
write N/A if not applicable

Emergency Medical Info

Emergency Contact Name and Phone Number *

Tip: Please Include Contact's Relationship to the Child

YOUTH CHURCH ACTIVITY WAIVER

Moose Jaw Church of God (herein referred to as MJCOG) "Living Room" Youth Group and its leaders, directors, officers, employees, contractors, agents, volunteers, members and representatives (collectively referred to as “Living Room Youth or LRY”), are not responsible for any injury, loss or damage of any kind whatsoever sustained by any person or their property while participating in events, activities or travel with LRY and all related activities associated with LRY, including injury, loss or damage.
ASSUMPTION OF RISKS
IN CONSIDERATION OF MJCOG allowing me or my child to participate in events, activities, or travel with LRY and all related activities associated with LRY, including all events on and off the LRY property and all activities related to the Youth Group (collectively referred to as the “Activities”), I acknowledge that I am aware of the possible Risks, Dangers and Hazards associated with participation in the Activities including the possible risk of severe or fatal injury to myself or others.

RELEASE OF LIABILITY and AGREEMENT
IN CONSIDERATION OF MJCOG allowing me or my child to participate in the Activities, I agree on
behalf of myself and/or my child:

1. TO ASSUME and ACCEPT ALL RISKS arising out of, associated with or related to my or my child’s participation in the Activities.
2. TO WAIVE and RELEASE MJCOG from any and all liability for any loss, damage, injury or expense that I or my child may suffer, or that my next of kin may suffer as a result of my or my child’s participation in the activities due to any cause whatsoever.
3. TO INDEMNIFY and HOLD HARMLESS MJCOG from any and all liability for any damage to the personal property of, or personal injury to, any third party resulting from my or my child’s participation in the activities.
4. TO INDEMNIFY and HOLD HARMLESS MJCOG from any and all claims, demands, actions and costs for any loss, injury, damage or expense whatsoever that might arise out of my or my child’s participation in the Activities.

YOUTH PARTICPATION CONSENT
Acknowledgment of Participant:
I, the undersigned Participant, understand that I am responsible to act in a safe and responsible fashion, to follow the instructions or directions of the persons in charge of the Youth Group, and to obey requests to comply with safety regulations as directed by the persons in charge of the Youth Group, including designated leaders and drivers of private or public transportation. I will be solely responsible for myself, will wear a seat-belt when available and will not disturb or distract the driver when using private or public transportation to travel to and from Youth Group activities.
At all Youth Group sports events or other activities, I acknowledge that it is my responsibility to obtain and wear appropriate safety equipment. I will not endanger the safety of others or myself at any activities, outings or sports events of the
Youth Group or when using private or public transportation for travel to and from such activities. I also understand that I may be photographed or appear in video for such purposes as LRY deems necessary.

Acknowledgment of Parent or Guardian of Participant:
We, the undersigned Parents or Guardians of the Participant, hereby authorize and consent to the Participant’s involvement in the Youth Group, including any use of private or public transportation deemed necessary by the persons in charge of the Youth Group for Participant travel to and from Youth Group activities, or to the NEAREST SUITABLE MEDICAL or HOSPITAL FACILITY in the event that emergency or other medical treatment not available at the site of a Youth Group activity is deemed advisable. We hereby consent to and authorize such emergency or other medical treatment of the Participant as may be deemed advisable in the event of accident, injury, or illness during the activities of the Youth Group.
We also understand that the participant may be photographed or appear in video for such purposes as the LRY deems necessary.

I UNDERSTAND THAT THIS IS A LEGAL AGREEMENT that is binding upon myself and my heirs, executors, administrators, successors and assigns. I HAVE READ AND UNDERSTAND THE TERMS OF THIS AGREEMENT and I ACKNOWLEDGE THAT by signing this agreement voluntarily, I am agreeing to abide by its terms and I am waiving certain legal rights that my child or I may have.

Do you agree to the waiver terms? *

Photo Permission *

Can we display photos that include your child(ren), taken at COG Youth Group Social Media pages and in church settings?

Do we have permission to contact your child(ren) *

Write yes for all, or specifically write yes or no if different for each child

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 of signature *

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