Volunteer/Youth Permission Form - HS001
Participant’s Full Name:
I, myself, or the undersigned parent and/or guardian of said youth, give permission for said youth to participate in all of Cornerstone Chapel’s Youth events for the years of 2021-2022. This would include activities in the building, activities on the property, activities off-site and transportation to and from events. I am confident that the adult leaders and sponsors will take appropriate care of my child and every effort will be made for his/her safety. However, I understand that accidents do occur, and in the event of an emergency, every effort will be made to contact me. In the event of an emergency, I hereby authorize an adult leader of this activity, as agent for me, to consent to any medical or dental treatment and care deemed necessary by medical personnel. In the event of a minor illness or injury (cold, headache, scrape, cut, sprain, etc.), I authorize the staff or medical personnel to make common remedies such as (check appropriate medication):
Tylenol Advil Benadryl Cough Drops
available to me or my child in dosages appropriate for his/her age, and to clean, bandage, or wrap wounds as necessary. I understand the risks associated with these treatments and over the counter medications.
While Cornerstone Chapel seeks to utilize precautions to reduce the spread of COVID-19, I understand that COVID-19 is spread in group settings, potentially even by asymptomatic carriers, and no one can guarantee that the Participant will not become exposed to or infected with COVID-19 or another contagious disease by engaging in these events. I understand contracting COVID-19 or other illnesses can result in injury, disability, or death in some cases. I understand that attending these events could increase the likelihood of participants contracting COVID-19 or other illnesses and/or spreading it to household and family members. Accordingly, I, myself, or the undersigned parent/guardian hereby assume all risk, including COVID-19, associated with the events Participant attends.
I, myself, or the undersigned parent and/or guardian of said youth, do release, acquit, discharge, and covenant to hold harmless and indemnify Cornerstone Chapel, its representatives, its volunteers and its activity leaders from any and all actions, damages, and liabilities arising out of any accident or sickness, or treatment thereof, incurred by said participant in connection with participation in Cornerstone Chapel programs or activities.
I myself, or the undersigned parent and/or guardian of said youth, verify that prior to the execution of this Agreement, I have conducted reasonable diligence (including, but not limited to, monitoring for fever or other signs/symptoms of COVID-19) and based on my reasonable diligence, participant does not demonstrate symptoms of COVID-19 as of the date I execute this Agreement. If participant does manifest symptoms of COVID-19 prior to the event, I will notify Cornerstone Chapel in writing and will not allow Participant to attend the event if contagious or demonstrating symptoms of COVID-19. I further agree to indemnify and defend Cornerstone Chapel against all claims related to COVID-19 arising out of participant’s connection to the event and/or for any claim that my child negligently spread COVID-19 to others at the event.
I agree to allow Cornerstone Chapel to use any photographic image of the minor taken while participating in the activity. These images may be used in promotions or other related marketing materials.
In the event of any dispute or disagreement between parties listed with respect to this agreement, each party shall appoint a representative whose task it will be to meet with the representative appointed by the other party for the purpose to resolve any dispute. No legal action regarding the dispute may take place until either one of the two representatives concludes in good faith that a resolution does not appear likely. At that time, the dispute shall be settled only by mediation and, if necessary, legally binding arbitration in accordance with the Rules of Procedure for Christian Conciliation of the Institute for Christian Conciliation, (complete text of the Rules is available at www.ICCPeace.com). In that case, Judgment upon an arbitration award may be entered by any court having competent jurisdiction, in conformity with the laws of the Commonwealth of Virginia. I understand these are the sole remedies to any dispute between me and Cornerstone Chapel.
I understand and acknowledge that, under the Uniform Electronic Transactions Act, by proceeding to register online and by signing this waiver electronically, such electronic registration and electronically signed Waiver will be valid and enforceable in the same manner as a hand-signed document that exists in physical form and that a record or signature may not be denied legal effect or enforceability under law solely because it is in electronic form.
I have read the above information; and, by signing here I give my authorization, dated May 21, 2022.
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Document Name: Volunteer/Youth Permission Form - HS001
Agree & Sign