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Legacy Youth Sign Up Form

Name *
Name
Date of Birth *
Date of Birth
Gender
Address *
Address
Cellphone Number
Cellphone Number
Home Phone Number *
Home Phone Number
School Year *
Emergency Contact Name *
Emergency Contact Name
Emergency Contact Number *
Emergency Contact Number
Swimming Confidence Level
The Parents or Guardians of the Participant, hereby authorize and consent to the Participant’s involvement in the St Chads Church and Community Centre youth program – “Legacy Youth’, including any use of private or public transportation deemed necessary by the persons in charge of the Youth Group for Participant travel to and from Youth Group activities, or to the nearest suitable medical or hospital facility in the event that emergency or other medical treatment not available at the site of a Youth Group activity is deemed advisable. We hereby consent to and authorize such emergency or other medical treatment of the Participant as may be deemed advisable in the event of accident, injury, or illness during the activities of the Youth Group. We also understand that the participant may be photographed or appear in video for any purposes St Chads Church and Community Centre deems. *
I understand St Chads Church and Community Centre (St Chads) and its leaders, staff, volunteers, and representatives are not responsible for any injury, loss or damage of any kind whatsoever sustained by any person or their property while participating in events, activities or travel with St Chads Church and Community Centre. *