Mission Trips and Retreats

(If you are signing up for middle school MODGNIK, you will need to contact the youth staff to receive the waiver form for the conference.)

Trip(required)

Student Name(required)

Student Age and Grade(required)

Parent/Guardian Name(required)

Parent Guardian Phone Number(required)

Email(required)

Home Address(required)

T-Shirt Size (Adult)(required) Small

Medium

Large

Extra Large

WAIVER, RELEASE, AND ASSUMPTION OF THE RISK I (We) acknowledge that my child’s participation in Lexington Presbyterian Church (LPC) activities is voluntary and may require traveling or physical exertion. Such activities may include, but are not limited to: outings, athletic games, local excursions and meetings, and other activities. I (We) acknowledge that my child’s participation in any LPC youth activity presents risks that I or my child may suffer including, but not limited to, damage to personal property, financial damage, emotional injury, illness, bodily injury, or death. I (we) hereby assume those risks. And, in consideration of my child’s being allowed to participate in the LPC youth program activities, I (we) agree and take the following actions for me and my child: I (we) waive, release, and discharge LPC, its pastors, directors, officers, members, employees, volunteers, representatives, subcontractors, and agents from any and all claims for: (A) Financial losses, including (but not limited to) insurance deductibles and medical expenses, that we as parents or guardians must pay as a result of injury or illness arising out of activities sponsored by LPC; (B) Damage, destruction, loss or theft of personal belongings of the minor participant or parents of the same; and (C) Any claims or liabilities that I (we) may assert as parents for loss of consortium, death or personal injury, which arise out of or relate to my child’s participation in LPC’s youth activities; and, to the extent allowable by law, all similar or identical claims that my child may assert. Notwithstanding any of the foregoing, LPC is not released from any claims or liabilities that are caused solely by LPC. I (we) agree not to sue any of the persons or entities mentioned above for any of the claims or liabilities that I have waived, released, or discharged herein. I (we) indemnify and hold harmless the person or entities mentioned above from any claims made or liabilities assessed against them as a result of my child’s actions. I agree to indemnify and hold harmless the person or entities mentioned above for any claims or liabilities assessed against them as a result of any inaccuracy in the information provided to LPC. I hereby execute this document for and on behalf of the minor named herein.By way of signature, please type I Agree if you consent to the WAIVER, RELEASE, AND ASSUMPTION OF THE RISK.(required)

Comment

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LPC Youth Ministry

Worship. Love. Serve.