Victory Church - Waiver Form Template 2025

Victory Church Conduct Covenant Liability and Release Form - Description of Activity: FEBRUARY 24, 2024, TRANSPORTATION IN PERSON VEHICLES DRIVEN BY SCREENED LEADERS, FROM VICTORY CHURCH TO Q-ZAR LASER TAG, 5836 MONROE ST. SYLVANIA, OH, AND PARTICIPATION IN LASER TAG. (Please acknowledge all by selecting the following box):

Acknowledged

CONDUCT COVENANT FOR YOUR INFORMATION: We expect each student to conform to these rules of conduct: No possession or use of alcohol, drugs, or tobacco. No students may drive during an event (without written parental permission). No fighting, weapons, fireworks, lighters, or explosives. No offensive, inappropriate, or immodest clothing. No boys in girls’ sleeping quarters and no girls in boys’ sleeping quarters. Participation with the group is expected. Respect one another, the staff, and adult leaders. Respect property. Respect and comply with event schedules. CONSEQUENTIAL PROCESS: Students who fail to comply with these expectations will for the first time be warned, the second time they will be required to call home and inform a parent of what they have done, and the third time be sent home at their parents’ expense. These steps are at the discretion of the event leadership. (Please acknowledge all by selecting the following box):

Acknowledged

STATEMENT OF HEALTH: I am confirming that I am in proper health and well being for the stated activity(ies), with no physical limitations, and the ability to properly perform the stated activity(ies), such as “swimming” for example. I have listed any restrictions by my signature below. (Please acknowledge all by selecting the following box):

Acknowledged

PERMISSION TO PARTICIPATE: I/we the undersigned, have legal custody of the student named above, a minor, and have given our consent for him/her to attend events organized by Victory Church. I/we understand that there are inherent risks involved in any ministry or athletic event, and I/we hereby release Victory Church, its pastors, agents, and volunteer workers from any and all liability for any injury, loss, or damage that may occur during the course of my/our child’s involvement. In the event that he/she is injured and requires the attention of a doctor, I/we consent to any reasonable emergency medical treatment as deemed necessary by a licensed physician. An “emergency” is defined as a situation wherein, in competent medical judgment, the proposed surgical or medical treatment or procedures are immediately or imminently necessary and any delay occasioned by an attempt to obtain a parent’s consent would reasonably jeopardize the life, health or limb of the person affected, or would reasonably result in disfigurement or impairment of faculties. In the event treatment is required from a physician and/or hospital personnel designated by Victory Church, I/we agree to hold such person free and harmless of any claims, demands, or suits for damages arising from the giving of such consent. I/we also acknowledge that we will be ultimately responsible for the cost of any medical care should the cost of that medical care not be reimbursed by the health insurance provider. I/we also agree to bring my/our child home at my/our own expense should they become ill or if deemed necessary by the student ministries staff member. (Please acknowledge all by selecting the following box):

Acknowledged

Participant First Name

Participant Last Name

Date Input

Birthdate

Gender

Participant Signature

Parent/Guardian First Name

Parent/Guardian Last Name

Date Input

Allergies ("N/A" if None)

Special Restrictions ("N/A" if None)

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

PARENT/GUARDIAN Phone Number

PARENT/GUARDIAN Email

PARENT/GUARDIAN Signature

Service Times

Contact Info

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