Student/Guardian Contact and Consent Form

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Parent / Guardian Information

 
 
 
 
 
Emergency Contact

 
 
Student #1 Information

 
 
 
 
 
 
 
Student #2 Information

 
 
 
 
 
 
 
Student #3 Information

 
 
 
 
 
 
 
Medical Consent

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PARTICIPATION AGREEMENT / MEDICAL RELEASE

I acknowledge that participation in the activity described above involves risk to the participant (and to the participant’s parents or guardians, if the participant is a minor), and may result in various types of injury including, but not limited to, the following: sickness, exposure to infectious/communicable disease, 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 the 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 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 in accordance with the rules of the American Arbitration Association.

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Photo/Media Release

I agree to allow the reproduction, dissemination, and/or publication of my or the attendee's name and likeness for media coverage, public relations, or any other purpose involving photographs, films, and/or video recording. This is to be done in conjunction with my participation in this activity. I understand and agree that I may neither pay a fee to receive individual promotional consideration from my participation in this activity nor will I receive any payment for the possible commercial use of my name or likeness.
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Communication Release

Living Hope is committed to creating a safe ministry environment. This includes promoting a healthy environment for digital communication between youth workers and students who participate in youth activities. As a result, our ministry has developed the following guidelines: 


Youth workers are not allowed to post or share personal information about minors through digital media without the signed consent of youth ministry participants and their parents or guardians, except in an emergency. Personal information may include such things as names, phone numbers, email addresses, and photos. 


Participants in our youth program are asked to comply with several conditions that apply when texting, emailing, instant messaging, group chatting, or posting content on websites related to our ministry. These guidelines also apply when communicating with youth workers and other people involved in youth ministry activities. 


Youth ministry participants: 


1. aren’t to make comments or share images that are sexually suggestive, disrespectful, or insensitive. Harassment and bullying are strictly forbidden. 


2. must obtain permission from an authorized youth ministry leader before posting photos or personal information about others involved in ministry activities on any website or social media site the ministry controls. 


3. Information, images, or videos shared on ministry websites or digital media channels are not considered confidential. 


Those who violate this policy may be blocked from Living Hope digital media channels or be removed from the youth program. Parents will be notified immediately of any violation.


[to read the full policy CLICK HERE]


Living Hope does not allow its youth workers to transmit or receive any electronic content that is illicit, unsavory, abusive, pornographic, discriminatory, harassing, or disrespectful. We also understand that the ministry can’t guarantee that all youths participating in ministry activities will abide by the policy’s terms. However, please realize that the ministry will seek to enforce the policy’s terms to the best of its ability. 


By agreeing with this policy Living Hope Youth workers have our permission to do the following: 


1. Communicate with our student(s) via text, church app, or Living Hope digital media channels.


2. Share our student’s name, mobile number, and email address with others involved in the ministry. 


3. Share photos and other information about our child on the Living Hope website and other digital media channels controlled by the ministry. 


If a dispute over this consent form or a claim for damages arises, we agree to resolve the matter through a mutually acceptable alternative dispute resolution process. If we can’t agree on a process, the dispute will be submitted to a three-member arbitration panel for resolution pursuant to the rules of the American Arbitration Association or a biblically-based alternative dispute resolution process.

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Digital Signature

 

Description

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