Rage Zone Waiver Form

YFC Canada

YFC is a national organization built on local chapters.

Registered Charity #106868847RR0001

YFC Peace Country

Registered Charity #106868847RR0001

Please fill out the form below to participate in the Rage Zone event!

A Rage Zone will be running throughout the event for ages 12 and up. The Rage Zone, where participating youth will wear safety equipment (safety goggles, mask, gloves, etc.) will be allowed to smash an object with a bat, hammer or other item.*
- I give permission for:
Participant Name*
First Last
Age
Address*
Street Address Address Line 2 City Province Postal Code
Health Card Number of Participant*
Parent/Guardian Name*
First Last
Parent/Guardian Phone*
Emergency Contact
Emergency Contact Info
- Same as Parent/Guardian above
Emergency Contact Name
First Last
Emergency Contact Phone*
Any physical disabilities or limitations; medications; allergies; etc.
Waivers and Conditions*
I agree
I hereby release Youth For Christ/Youth Unlimited, its staff and sponsors, from responsibility and liability for any injury or illness that my child may sustain during this activity, knowing that reasonable precautions for the health and safety of the children will be taken.

In the event of an emergency, I hereby authorize an adult leader of this event, as an agent of me, to consent to any x-ray examination; medical, dental or surgical diagnosis; treatment; and hospital care advised and supervised by a physician, surgeon or dentist (as appropriate) licensed to practice under the laws of the province of Alberta, either at a doctor’s office or in any hospital. I expect to be contacted as soon as possible.

The parents/guardians are responsible for any additional expense that may result from such services.

I have read, understood, and hereby grant permission for my child to participate fully in the activity described above and agree to these waivers and conditions.
Is the participant 18 years old or older?
- Yes, participant is 18+
Participant Signature*
Your Name
Your Name
Your Name
Parent/Guardian Signature*
Your Name
Your Name
Your Name

Rage Zone Waiver Form

Emergency Contact