An example of making your own "release form" for youth group outings. It is also a good idea to have one on file for any youth attending your program, so you can get in touch with them and parents especially in emergencies…
Name of Minor Today's Date
In Consideration for being accepted by ________________California, which shall be referred as ___________, for participation in: (Please circle one)
A: _______________________, meets every Wednesdays, during the school year from 7pm to 9pm, and during the summer every other week.
B: _______________________, meets _______________, during the school year from __________.
C: _______________________, meets _______________, during the school year from __________.
As a parent/ Guardian of above minor youth and participant in the above program, I do hear by release, forever discharge and agree to hold harmless __________, and the directors/ pastors/ volunteers thereof, from any and all liability, claims, or demands for personal injury, sickness or death, as well as property damage and expenses.
This release covers transportation provided by __________ and its representatives who are properly licensed to drive in the state of California: And meetings on the ___________ campus site or any other site during programs and activities: And refreshments, purchased or homemade that will be served at above program: And Consent for emergency Medical or Dental Treatment, including examination, diagnosis, treatment, anesthetic, and surgical treatment, the undersigned agrees to pay for all costs and expenses. Please write on back page any allergies, or medical problems, or medications.
This Liability Release Form will remain in effect as long as the named minor child/ youth is a participant in the program, or the child/youth reaches adulthood at 18.
Insurance Co.___________________________ Home Phone___________________
Name of Insured_________________________ Cell Phone_____________________
Policy #________________________________ Work Phone___________________
I have read the above and understand the information:
Signature of parent/guardian Print your name
Date______________________ Accepted by__________________________
Today's date Youth Pastor/ Church Secretary
(Make sure you check with your churches insurance company and denominational resources first)