Youth Night Waiver Form

YFC Canada

YFC is a national organization built on local chapters.

Registered Charity #106868847RR0001

Registered Charity #86135 4769 RR 0001

Youth Unlimited North Glengarry

YU North Glengarry Programs Summer Camp Registration Events Contact Us

Participant's Name(Required)
First Last
Parent/Guardian's Name(Required)
First Last
Participant's Address(Required)
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Participant's phone number(Required)
Emergency Contact of Participant(Required)
First Last
Emergency Contact Phone Number(Required)
Participant's Health Card number(Required)
Health issues and special considerations to be aware of?
Consent and Liability Waiver Form(Required)
- I hereby declare that my son/daughter is allowed to participate fully in activities associated with the Youth Nights. I understand that at the event my son/daughter may participate in different activities that are supervised by staff and volunteers. I also agree that my son/daughter will be bound by the rules of the leaders of these activities and the rules of any place or organization where the activities may be held. I know I may contact the Area Director, Rebecca Goulet 613-360-5252 to acquire further information about this event. In consideration of my son/daughter’s participation in this event, organized and supervised by Youth Unlimited North Glengarry and Gerry & Rebecca Goulet, I hereby release, waive, and discharge Youth Unlimited North Glengarry, Eastern Counties (ON) YFC Inc., including their staff, organizers, volunteers and participants, on my son/daughter’s behalf from any and all liability, loss, injury or death which may be suffered, sustained or arise in any way whatsoever as a result of or in conjunction with these activities. This event could involve the following possible injuries: Car accident, sun stroke, falls, body contact sports, burns
Transportation Consent Form(Required)
- I consent to my son/daughter being transported to and from this event in a vehicle operated by a YFC Summer Worker/Staff, YFC Summer Volunteer/Chaperone, or the YFC Area Director.
- I do not consent to my son/daughter being transported to and from this event in a vehicle operated by a YFC Summer Worker/Staff, YFC Summer Volunteer/Chaperone, or the YFC Area Director.
Please check on of the followings regarding photos taken during Youth Nights(Required)
- I agree that photos, videos taken of my son/daughter while on this event outing may be used in the future by Eastern Counties of Ontario Youth for Christ.
- I do not give permission to Eastern Counties of Ontario Youth for Christ to use photos, videos taken of my son/daughter while on this event.
Date(Required)
Signature of Participant(Required)
Signature of Parent/Guardian(Required)