Gym Night Registration

Consents and Releases
Purposes and Extent:(Required)
LYU is collecting and retaining this personal information for the purpose of enrolling your child in our programs, to develop and nurture on-going relationships with you and your child, and to inform you of program updates and upcoming opportunities at our organization. This information will be maintained indefinitely as it is a requirement of our insurance company and legal counsel. If you wish to limit the information collected or to view your child’s information, please contact us.
Medical Consent:(Required)
I/we, the parents or guardians named above, authorize Lakefield Youth Unlimited (LYU) to administer any first aid treatment necessary, and in the case of medical emergency, to authorize any physician or hospital to provide a medical assessment, treatment or procedures for the participant named above. LYU and representatives together, will do everything in their power to contact parents or emergency contacts before such action, if a problem should arise.
Responsibility:(Required)
I/we acknowledge that it is my responsibility to take the necessary steps for insuring against personal injury, property damage, or any loss by my child or by self. I also acknowledge that I must assume total responsibility for ALL medical coverage, accidental insurance and personal injury, or any other loss or damage. I will also pay for the cost to have my child sent home if he/she is unwilling to comply with the rules.
Faith Disclosure:(Required)
I/we understand that LYU is a non-denominational, faith-based, not-for-profit organization that is governed and operated by Christian values, principles and beliefs. I/we understand that LYU is inclusive to all participants regardless of their personal religious belief, race, sexuality, socio-economic status, or gender. I/we understand that the staff and volunteers of LYU, with the utmost dignity and respect, may engage in discussions, conversations and/or lessons regarding topics of faith with my child during the course of their participation with LYU and its affiliates.
Photos/Media Release: I/we (do/do not) authorize LYU to take, use and own, in perpetuity, names, photographs, or recordings of the students; understanding that these photos or recordings may be used for public promotional purpose (such as newspaper articles, newsletters, Facebook, other media outlets, etc.). LYU does not sell or give away any recorded materials or mailing list information.(Required)
- Agree
- Disagree
Communication: A policy is in effect that communications is to be used solely for the dissemination of information. I/we agree to permit LYU staff or volunteers to communicate with applicant student via telephone, email, social media or text.(Required)
- Agree
- Disagree
Parent/Guardian Acknowledgement(Required)
Acknowledged
By participating in this registration process and the corresponding activity, I/we, named below, undertake and agree to indemnify and hold harmless LYU, KYFC, its trustees directors corporation members, servants, agents, volunteers, employees, and all program personnel from any and all actions, claims, and demands whatsoever whether existing as of this date or in the future; and, against any loss, damage or injury suffered by the participant as a result of being part of the activities of LYU, as well as of any medical treatment authorized by the supervising individuals representing LYU. This consent and authorization is effective only when participating in or travelling to events sponsored by LYU.
I have read, understood, and agree with the above and sign it to cover all the student activities associated with the Lakefield Youth Unlimited Program. (please type your written name and sign below)
Date Signed
Signature
Your Name
Your Name
Your Name

Gym Night Registration

Step 1 of 3

Parent/Guardian/Caregiver Contact Information

Consents and Releases