Cornerstone Baptist Church in Orillia: Under-18 Volunteer Waiver

Youth's Name *

Youth's Date of Birth *

Address *

Primary Phone Number *

Secondary Phone Number

Parent Email *

Youth's Health Card Number *

Family Doctor *

Doctor Phone Number

Allergies / Special Notes

Does your youth have any physical, emotional, mental, behavioural concerns or limitations that our staff should be aware of? *

Yes

No

If yes, please explain.

Is your youth bringing any medication with him/her? *

Yes

No

If yes, please list.

Parent/Guardian Name: *

In case of an emergency and we are unable to contact you at the phone numbers listed aboveed above, please provide an alternate contact name, relationship to your youth and phone number who we can speak with. *

Medical Waiver *

I agree

I disagree

I/we, the parents or guardians named above, authorize Shara Aldom or one of the Cornerstone Baptist Church, Orillia Ministry Personnel, to sign a consent for medical treatment and to authorize any physician or hospital to provide medical assessment, treatment or procedures for the participant named above.

Indemnification Waiver *

I agree

I disagree

I/we, the parents or guardians named above, undertake and agree to indemnify and hold blameless Cornerstone Baptist Church, Orillia, the Board of Elected Elders and Ministry Personnel from and against any loss, damage or injury suffered by the participant as a result of being part of the activities of Cornerstone Baptist Church, Orillia as well as of any medical treatment authorized by the supervising individuals representing the church. This consent and authorization is effective only when participating in or traveling to or from events of Cornerstone Baptist Church, Orillia.

Photos Waiver *

Brochures/Promotional Material

Church Service

Website

Newsletters

None

I/we, the parents or guardians named above, GRANT PERMISSION for the reasonable use of pictures containing our youth in any or all of the following ways (please indicate any or all):

Activities Waiver *

I have read, understood and agree with the above and sign it to cover my youth's participation in the activities listed below.

Comments

Under-18 Volunteer Waiver

VBS 2024 Under-18 Volunteer Waiver

SECTION 1

SECTION 2

VBS Trip Activities