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Yes, you can use pictures and videos of my child. I hereby grant Veritas Church Cedar Rapids the permission to use my child’s likeness in photographs, video, and other media in any and all of its publications, including but not limited to bulletin boards, social media, and website entries. I waive any right to royalties or other compensation arising or related to the use of the photographs or videos.
No, please do not print or publish photos of videos of my child online or in church-related publications.
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The Trip
Participants Name
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Parental Contact Information
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Liability Release
For participation in all of the functions, activities, events or otherwise during the date of, Saturday, January 20th, 2018, during travel, at Sundown Mountain Ski Resort, or any other location we are during the course of the day, I do for ourselves (myself and on behalf of my child-participant) hereby release, forever discharge and agree to hold harmless the organizers, and church sponsors from any and all liability, claims, or demands for personal injury, sickness or death, as well as property damage and expenses, or any nature whatsoever which may be incurred by the undersigned and the child-participant that occur while said child is participating in the activities and functions of the above mentioned retreat. We (I) on behalf of my child-participant hereby assume all risk or personal injury, sickness, death, damage and expense as a result of participation in recreation and other activities involved therein. We are (I am) the parent(s) or legal guardian(s) of this participant, and hereby grant our (my) permission for him/her to participate fully in said retreat and hereby give our (my) permission to take said participant to a doctor or hospital and hereby authorize medical treatment, including but not in limitation to emergency surgery or medical treatment, and assume the responsibility for all medical bills, if any. Further, should it be necessary for said participant to return home due to medical reasons, disciplinary action or otherwise, we (I) hereby assume all transportation costs. Please sign below. I understand that typing below constitutes a legal signature confirming that I acknowledge and agree to the above.
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Student Commitment
I agree to abide by the retreat policies and rules of conduct for participating at this retreat. I agree to respect the authority of the leaders in charge. I understand that one instance relating to behavior in an unacceptable way can warrant an automatic call to my parents and/ or a trip home. The participant must enter their name having read and understood this statement.
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A covenant is an agreement in partnership with God between members of a community. As a participant in Veritas Students activities and trips, I am agreeing to enter into a covenant relationship. I agree to be open minded, flexible, and compassionate, showing respect for other people, their bodies, their property, their cultures, and their beliefs. I agree to listen to directions, to be mindful of safety, and to abstain from any behavior that harms or endangers myself, others, or the health of the group, including but not limited to bullying, sexual activity, harassment, violence, negativity, displays of affection, and possession or use of weapons, tobacco, alcohol, or drugs that are not prescribed to me. I agree to stay out of sleeping areas of the opposite gender and adhere to lights out and wake up times. I agree to focus on building relationships and on creating a spiritually uplifting atmosphere. I agree to not make any major body alterations without expressed written and verified parental consent (body piercing, tattoos, etc.). I agree to not gamble, use profanity, use electronic devices (i-pods, hand-held games, cell phones, etc.) during activities or trips where they have been restricted or not allowed. I agree to wear modest attire. I agree to adhere to the following guidelines on modesty: As Ambassadors of Christ, as well as representatives of our church, we want to avoid attire that might distract or be a stumbling block to anyone. (This dress code is encouraged during weekly youth group meetings and required during extended events like trips and retreats.) Tops: T-shirts with sleeves only. No tank tops, muscle shirts, halter tops, tube tops, bare midriffs, etc. Bottoms: Shorts must extend down as far as your fingertips when your arms are extended straight down. Form fitting pants are discouraged, if worn you may be asked to cover up with a sweatshirt, sweater, or something similar. Any shorts or pants should also cover your underwear. Swimsuits: Make sure they’re modest, no torso-revealing, cleavage-showing or bikini-style suits. We’ll give you a t-shirt if your suit isn’t modest enough. Pajamas: Same “tops” and “bottoms” rules apply when in presence of opposite gender. I agree to speak up about my own needs and to speak to an adult immediately if I feel unsafe or if I witness breaches of this covenant. I understand that when we keep our covenant promises to each other, we co-create with God a safe, thriving environment in which we are all lifted up. When we break this covenant with each other, we break trust and disrupt our ability to operate as a safe and loving community. I understand that should I decide to break this covenant, I may be asked by adult leaders to leave the activity or event and be subject to additional consequences. At the discretion of the Ministry Director/Leader and/or the adult leaders, I may also be referred to and expected to speak with Church Leadership to discuss my choices before being allowed to participate in future Student Ministry activities.
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Insurance Information
List any and all current medications
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Allergies? Food and Medication
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Medical Information/Comments
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Insurance Company Name
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Insurance Policy Information
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Emergency Contact Information. Please submit at least two contact's phone numbers.
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Photo Release
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