YTH Waiver

This form grants Westwood Church the right to care for a child when they are attending Westwood events during the 2024-25 year.

I am filling this out for a...

Middle School Student (6-8th)

High School Student (9-12th)

YTH Waiver - Student Info

Student's First Name

Student's Last Name

Birthdate

Grade (Select One)

YTH Waiver - Student Info

Student's First Name

Student's Last Name

Birthdate

Grade (Select One)

YTH Waiver - Parent/Guardian Info

First Name

Last Name

Phone Number

Email

Relationship to Child

YTH Waiver - Emergency Contact/Medical

Emergency Contact First Name

Emergency Contact Last Name

Phone Number

Insurance Carrier

Group Number

Policy Number

In the event of circumstances which indicate that my child is in need of medical care, I authorize the Westwood Church representatives to consent to any necessary X-ray, examinations, medical or surgical diagnosis, treatment, medication, or hospital care in accordance with standard medical practice by licensed medical personnel. I release and agree to hold Westwood Church, its employees and volunteers, harmless from any claims due to illness or injury suffered by my child in the course of receiving such medical responsibility and consequences that may arise as a result of this treatment. I grant permission to the employees and agents of Westwood Church to give my child non-prescription drugs in the event circumstances reasonably demonstrate that my child is in need of such non-prescription drugs.

Allergies/Medical Conditions (Please provide details)

YTH Waiver - Final Release

Functions and Activities

It is my understanding that participating in the programs and recreational and other activities of Westwood Church is a privilege. Prior to my own/child’s participation in such activities, I acknowledge that there are certain risks associated with the activities, including, by way of example, physical injury due to activity-related accidents, physical injury due to transportation-related accidents, illness, or even death. In addition, I acknowledge that there may be other risks inherent in these activities of which I may not be presently aware.

Release of Liability

By signing this Permission/Waiver Form, I expressly warrant that the child named above is capable of withstanding both the physical and mental demands of the activities discussed above. I also expressly assume all risks of the child when participating in the activities, whether such risks are known or unknown to me at this time. I further release Westwood Church and its staff, leaders, employees, volunteers, and agents from any claim that my child may have or that I may have against them as a result of injury or illness incurred during the course of participation in the activities. This release of liability is also intended to cover all claims that members of the child’s or my family or estate, heirs, representatives, or assigns may have against Westwood Church or its staff, leaders, employees, volunteers, or agents from any and all claims arising from my participation in its activities and programs, or as a result of injury or illness of my child during such activities.

Photography

I authorize Westwood Church to include myself/child in pictures for promotional purposes of events he/she is participating in. I understand that my child’s full name will not be published with the pictures he/she is in.

Signature

By typing your name in this box you are agreeing to the terms in this form and the information you provided is true to the best of your knowledge.

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