Activity COnsent Form

REQUIRED FOR INDIVIDUAL YOUTH REGISTRANTS NOT SUPERVISED BY AN ADULT. Group Registrants are required to supervise and chaperone their own youth and children and therefore should not fill this form out.

This form is only for parents or guardians of youth individual registrants that are attending the Alive Youth Rally and will not be chaperoned or supervised. If you prefer to download a PDF to print (CLICK HERE), you may fax it to: 864-576-2247 or scan and email it to info@alivesc.com, after registering Attendee, and we will have it with their registration.

Name of Registered Youth:(Required)

First Last

ONLY for individual registrants who are youth (13-17) not supervised by an adult.

Youth Activity Consent (For ages 17 and under, not supervised by an adult)(Required)

I am giving consent to this:

I am the parent or guardian of the Youth listed above and provide consent for my minor child (party under the age of consent in the State of South Carolina) to participate in the ALIVE YOUTH RALLY (“ALIVE”) at the Spartanburg Seventh-day Adventist Church (“Church”) in Spartanburg, SC on March 3-4, 2023.

I acknowledge and agree that the nature of participation in ALIVE may involve (a) physical activity, (b) contact with unfamiliar persons but those granted permission to be on premises of the Church, and (c) other potential risk of injury. Notwithstanding the preceding sentence, I willingly and freely agree to have my minor child participate in ALIVE and hereby assume any and all risk, and agree to release the Church from all liability for such risk, including without limitation risk of any accident, injury, illness or death to person or property which my child may sustain, in connection with participation in ALIVE or in any ALIVE-related project or activity.

The parent or guardian hereby grants to the Church the unqualified and perpetual right to use, and consents to the use of, the name and likeness of the above-named child in connection with the use by the Church of photographs and/or video worldwide and in any and all media, including, by way of illustration, but not limited to, the display of still photographs, the inclusion on the Internet (i.e. website or social media) and the preparation and dissemination of any advertising and promotional materials used to promote ALIVE.

In case of emergency, the parent or guardian understands that every reasonable effort will be made to contact him/her. In the event that the parent or guardian cannot be reached, the parent or guardian gives permission for the above-named child to be given emergency medical treatment and/or transportation to emergency medical care if necessary in the event of accident, injury or sudden illness while said minor child is a participant in ALIVE. The parent or guardian agrees to accept all financial responsibility for any such emergency medical treatment and transport. The parent or guardian also agrees to provide the following medical information on this form.

Please state any current medical problems: (If none, state “none”.)(Required)

Please note any medications currently taken by your child: (If none, state “none”.)(Required)

Please state any restrictions and/or limitations to physical activity: (If none, state “none”.)(Required)

Date of Last Tetanus Booster:

Allergies to Drugs or Food:

Family Physician and Phone #:

Insurance Provider:

Insurance Policy #:

Parent or Guardian Name:(Required)

Parent or Guardian Phone:(Required)

Parent or Guardian Email:(Required)

Emergency Contact Name:(Required)

Emergency Contact Phone:(Required)

Signature (parent or guardian):(Required)