C.O.D. (Call of Duty)
Youth Group Emergency Contact / Waiver Form
Davidson Community Bible Church – September 2014 to August 2015
Program information
Our bi-weekly regular events are designed for grades 7-12, and take place either at the church, or at a prior announced and planned location. C.O.D. will be led under the guidance of Jeff Keown. There will also be other qualified volunteer adults who will be helping to supervise. As per church policy and safety guidelines, all adult leaders will have been asked to provide a criminal and vulnerable sector records check to the church office.
Our events will generally take place every second Friday from the hours of roughly 7 pm to 10 pm. Our events will consist of games, high energy activities, occasional outings, snacks, and spiritual guidance and teaching.
On the events where we go on outings, we will be arranging for transportation to and from the church. All driving will be done by qualified and safe adult drivers.
About this form
To fulfill insurance requirements, church policy, and to protect the attending students, leaders, and the facility, we require all students to complete and submit this waiver form to cover C.O.D. involvement for the year. For all special trips (such as a camp out or retreat), we will be asking for an additional permission form per event.
Thank you for your cooperation. If you have any questions please contact Davidson Community Bible Church.
Guidelines for youth group
Possession or use of Illegal drugs or alcohol, illicit material, fireworks, or weapons of any kind, etc. will not be tolerated. We ask that all who come to C.O.D. act in a way that promotes safety for themselves and among others. Parents and proper authorities will be contacted as needed.
Required information
Name: ______
Date of Birth:______School:______
Grade: ______
Home address:______
Email address:______
Parent(s)/Guardian(s) Name(s): ______
Phone 1: ______Phone 2: ______Email:______
Medical Conditions /Allergies (food and medicine also): ______Emergency Contact: ______
Emergency Phone: ______
Health Card Number: ______
Waiver
I ______hereby release and discharge Davidson Community Bible Church, event sponsors, employees, volunteers, and workers from all actions, suits, and demands whatsoever in law or in equity, including, but not limited to, the risk of injury from participating in C.O.D. at Davidson Community Bible Church (DCBC), 2014-2015, and the risk of loss of personal property by theft or otherwise.
I give signed permission to allow my youth to be transported to and from events away from the church site by qualified adult drivers.
I give staff personnel and leaders authority to act on my behalf and to release the above medical number to authorities in the case of an emergency and authorize treatment if necessary (acknowledging that the emergency contact person will be notified as soon as possible), understanding that I am financially responsible for any costs not covered by Saskatchewan health care.
Further, I understand that during the course of C.O.D. events, there may be photo, video, or audio recording for the purposes of program promotion and advertising within the church and community. I hereby grant full permission for DCBC to record any or all participation in these events via photos, video, or audio, for purposes of advertising and promotion without any reimbursement of any kind due to me or the need to pay any fee.
Legal Guardian Name (print):
______
Signature and Date:
______
COMPLETE FORM AND GIVE IT TO A YOUTH LEADER
Davidson Community Bible Church
400 3rd Street – Davidson SK
306-567-2870