EVENT DESCRIPTION This youth outing, scheduled to take place on Saturday, July 12, 2025, at Lake Milton State Park, will include various water-based and outdoor activities such as boat riding, tubing, swimming, and fishing. While all reasonable safety measures will be taken, these activities inherently involve a risk of injury or accident. PARTICIPANT INFORMATION Child's Name * First Name Last Name Child's Date of Birth * MM DD YYYY Age Second Child's Name First Name Last Name Second Child's Date of Birth MM DD YYYY Second Child's Age PARENT/GUARDIAN INFORMATION Parent/Guardian's Name * First Name Last Name Parent/Guardian's Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Parent/Guardian's Phone * (###) ### #### Parent/Guardian's Email * Secondary Contact * Contact this individual if the parent/guardian is unavailable. First Name Last Name Secondary Contact's Phone * (###) ### #### Secondary Contact's Role * What's their relationship with the child? Parent/Guardian Grandparent Aunt/Uncle Cousin Family Friend PARENTAL PERMISSION Parental Permission * Do you, the undersigned, parent or legal guardian of the above-named student/students, I give your permission for your child (children) to attend and participate in the Lake Day Event sponsored by Metro Assembly of God on the date listed above. Yes WAIVER Hold Harmless and Liability Waiver * I understand that participation in this event may involve physical activity and certain risks, including but not limited to injuries related to water activities, transportation, and outdoor recreation. In consideration for allowing my child (church) to participate, I hereby release, waive, discharge, and covenant not to sue Metro Assembly of God, its pastors, staff, volunteers, leaders, or representatives (hereafter referred to as “the Church”) from any and all liability, claims, demands, actions, or causes of action arising out of or related to any loss, damage, or injury that may be sustained by my child (children) while participating in this event or during transportation to and from the event, whether caused by negligence or otherwise. I further agree to indemnify and hold harmless the Church from any loss, liability, damage, or cost due to participation in the event. Yes AUTHORIZATION Medical Authorization * In the event of an emergency, do you authorize the adult leaders of Metro Assembly of God to obtain necessary medical treatment for my child. This includes first aid, CPR, transport to a medical facility, or any medical procedures deemed necessary by licensed professionals. Do you also understand that every effort will be made to contact you or the secondary contact as soon as possible. Yes KNOWN ALLERGIES/MEDICAL CONDITIONS/MEDICATIONS Please list and known allergies or medical conditions your child (children) have. Please list any medications your child (children) are taking. SIGNATURE AND ACKNOWLEDGEMENT Typed Electronic Signature and Acknowledgement * By signing below, I acknowledge that I have read, understood, and agree to the above terms, and that this waiver and authorization shall be effective and binding for this event. Date Signed * MM DD YYYY Time Signed * Hour Minute Second AM PM Thank you!
