Statement of Risks of Participation

I/We understand that my involvement (or that of my child or other person for whom I have a legal responsibility) in Saint Alban’s Episcopal Church Youth Ministry activities is entirely voluntary. I also understand that some of the activities I will be engaged in will involve risks. This risk may include, but not limited to those involved in construction, travel, and recreational activities (such as swimming, hiking, climbing, or other strenuous physical activity.)

I understand that my participation in this program is at my own risk, and I take full responsibility for my own welfare. I will be responsible for all legal and financial responsibilities for payment of any medical, hospital and emergency care. I will provide health insurance information as requested.

I, for myself, and for my successors of every kind, by my signature hereby release Saint Alban’s Church, its staff, vestry and volunteers from liability for any accident, illness or loss that I may sustain while, or as a result of participating in this program.

In the case of an emergency I give permission for the acting site leader or other person in charge to provide me reasonable and necessary medical care including access to available professional medical care.

Youth Mission Participant: Release of Liability Form

(Typing your initials indicates your consent and intention that you have read the above statement on possible risks, and that you agree to release of liability.)
(Typing your name in this field indicates your consent and intention that it be your digital signature.
(Typing your name in this field indicates your consent and intention that it be your digital signature.