Parental/Guardian Consent Form and Liability Waiver Please check the appropriate box: What programs does your child(ren) partake in? Little Saints My Father’s Daughter My Father’s Son Teen Ministry Child's Information Child's Name * First Name Last Name Child's DOB * MM DD YYYY Child's Age * Child's Gender * Male Female Child's Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone (###) ### #### Email Parent / Guardian Information Parent/ Person legally responsible for this child if other than parent Name First Name Last Name Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone (###) ### #### Email As parent and/or legal guardian, I remain legally responsible for any personal actions taken by the above-named minor participant. I agree on behalf of myself, my child named herein, or our heirs, successors and assigns, to hold harmless and Victorious Living Church its officers, directors and agents, and Victorious Living Church representatives associated with the event, from any and all actions, claims, demands, damages, costs, expenses and all consequential damage arising from or in connection with my child attending the event or in connection with any illness or injury or cost of medical treatment in connection therewith, and I agree to compensate the Organizer, its officers, directors and agents, or representatives associated with the event for reasonable attorney’s fees and expenses arising therewith. Electronic Signature * I, the Parent/Guardian named above, grant permission for my child, named above, to participate in field trips that requires transportation. These activities will take place under the guidance and direction of employees and/or volunteers from Victorious Living Church Youth Department. Name First Name Last Name Electronic Signature Agreement * By selecting the "I Accept" button, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Agreement. By selecting "I Accept" you consent to be legally bound by this Agreement's terms and conditions. I Agree Thank you!
