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Youth Group Registration Form
First Congregational United Church of Christ
815 S. Concord Rd.
Oconomowoc, WI 53066
Youth's Full Name *
Your answer
Date of Birth *
MM
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DD
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YYYY
Grade *
Your answer
Guardian(s) Name *
Your answer
Address *
Your answer
Primary Phone Number *
Your answer
Youth's Cell Phone Number (if providing you are granting permission to contact them with Youth Group information)
Your answer
Primary email(s) to receive Youth Group information *
Your answer
Medical Information
In the event the parent/guardian is not available, list one other name & phone number to notify in case of emergency.
Additional Contact Name *
Your answer
Additional Contact Phone Number *
Your answer
Any medical issues, diets, allergies, allergies to medications, or have had major illness or surgery within the last twelve months, please note them below.
Your answer
Parent Authorization
In the event of an injury or illness, I give permission to the leaders to secure necessary medical treatment, and I relieve them of any and all liability in such an event, understanding that I will be contacted promptly if such a situation arises.
I understand that the church may record the image, voice or likeness of the applicants. I hereby give permission for First Congregational UCC to use images in conjunction with publicizing events without remuneration to me or my child(ren).
Personal information is not released in any publicity materials without the expressed consent of the parent.
I have read, understood, and signed the Release of Liability on the BACK OF THIS FORM.
This form remains in effect from September 8, 2019 through September 9, 2020 or until revoked by the parent or guardian. It is the parent’s responsibility to inform First Congregational UCC of any changes or additions.
Signature- Full Name, Date and Relationship to youth *
Your answer
Release of Liability
I give my permission for my child to accompany pastors, youth advisors, and/or recognized youth chaperones of First Congregational United Church of Christ on Church sponsored youth outings and activities. I understand there are dangers and risk of injury inherent in participating in these youth outings and activities, but still desire to allow the above named youth to participate in such activity.

Therefore, the undersigned, for and in consideration of the opportunity to allow the youth to participate in youth outings and activities, and for other good and valuable consideration, does hereby forever release, quit and forever discharge First Congregational United Church of Christ, its pastors, youth advisors, employees, insurers, agents, servants and recognized youth chaperones (hereafter referred to as “Released Parties”) from any and all claims, demands, rights and causes of action of any kind or arising out of any and all known and unknown, foreseen or unforeseen bodily and personal injuries, property damage or the consequence thereof, resulting from any accident, casualty or event involving the above-named youth participant and arising out of participating in Church sponsored youth outings and activities.

I UNDERSTAND THIS MEANS I AGREE NOT TO SUE ANY AND ALL OF THE RELEASED PARTIES FOR ANY INJURIES OR PROPERTY DAMAGE RESULTING TO THE ABOVE NAMED YOUTH PARTICIPANT DURING OR IN CONNECTION WITH HIS OR HER PARTICIPATION IN CHURCH SPONSORED YOUTH OUTINGS AND ACTIVITIES.

I understand this Release does not waive liability for intentional or reckless acts, as such claims cannot be waived, but do understand this Release waives claims of any other king, specifically including claims for negligence, against the Released Parties.

FURTHER AND BY WAY OF INDEMNITY, the undersigned hereby expressly understands and agrees to indemnify and hold harmless the Released Parties, their employees, agents or insures, against any and all claims or damages, costs of expenses, incurred by the Released Parties, there employees, agents or insures, as a result of any accident or injury which might occur while the above-named youth participant is participating in Church sponsored youth outings and activities and which may result from the negligence of the Release Parties, their employees, and agents, third parties or any combination thereof.

The undersigned further declares and represents that no promise, inducement or agreement not contained in this written agreement has been made to the undersigned and that this Release contains the entire agreement between the parties and the terms of this Release contractual and not a mere recital. The undersigned further acknowledges the opportunity to negotiate this Release with an authorized member of First Congregational United Church of Christ.

THIS IS A RELEASE AND WAIVER OF IMPORTANT RIGHTS! PLEASE READ CAREFULLY AND SIGN ONLY AFTER FULLY UNDERSTANDING ITS CONTENTS!
Signature- Full Name, Date *
Your answer
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