Refuge Release Form
(A Ministry of Calvary Chapel Sevier Valley)
Email address *
Students and Parents,
Sevier Valley Youth Refuge is a rec-center activity with no religious programming. It is open to the public, it is a come and go as you please, open house type atmosphere, similar to any other rec-center, arcade, or community park. We work hard to provide a safe, healthy environment inside of the building and outside our front doors, but kids are not forced to stay inside or even on the property. Refuge cannot assume responsibility for students that leave and head to other locations. While they are on property we expect them to abide by the following simple rules:

1. Must show a valid school id to staff when coming to Refuge. Must be in grades from 6th to 12th.

2. Respect others, their personal space, their stuff, and their right to be safe and secure, including Refuge staff, other students, and any other person in the building or around the property.

3. The use, promotion, or possession of any illegal substance will result in an immediate phone call to local authorities. This includes all vape and tobacco products.

4. Do not damage or vandalize the building, property, or our neighbor’s property.

5. The surrounding properties are private (including the motel and service station) so we ask that you stay off and away from any of these properties.

6. Please abide by all traffic safety laws including staying out of the streets and using proper cross-walks and procedures.

7. Understand if you break these rules, you will be asked to leave Refuge either temporarily or permanently depending on the severity of your actions.

Liability Release
THE UNDERSIGNED INDIVIDUAL ATTESTS THAT THEY ARE THE AUTHORIZED PARENT OR LEGAL GUARDIAN FOR THE REGISTRANT. FURTHER, THE UNDERSIGNED ACKNOWLEDGES THAT CALVARY CHAPEL, ITS BOARD OF DIRECTORS, OFFICERS, EMPLOYEES, AGENTS, AND/OR VOLUNTEERS SHALL NOT BE LIABLE FOR ANY DAMAGES OR INJURIES TO THE REGISTRANT DURING THE ACTIVITY OR PROGRAM. THIS RELEASE SPECIFICALLY INCLUDES DAMAGES OR INJURIES SUSTAINED DUE TO THE NEGLIGENCE OF THE CALVARY CHAPEL DIRECTORS, OFFICERS, EMPLOYEES, AGENTS, AND/OR VOLUNTEERS.
I AM AWARE THAT THIS ACTIVITY AND/OR PROGRAM MAY INVOLVE PARTICIPATION IN AREAS OF POOR LIGHTING, ROUGH TERRAIN, AND OTHER NATURAL AND MAN-MADE ELEMENTS THAT COULD RESULT IN INJURY. THE UNDERSIGNED HEREBY ASSUMES ALL RISKS AND FINANCIAL RESPONSIBILITY THEREFOR, AND RELEASE CALVARY CHAPEL AND ITS BOARD OF DIRECTORS, OFFICERS, EMPLOYEES, AGENTS, AND/OR VOLUNTEERS FROM ALL LIABILITY, REGARDLESS OF WHETHER IT STEMS FROM THE NEGLIGENCE OF CALVARY CHAPEL DIRECTORS, OFFICERS, EMPLOYEES, AGENTS, AND/OR VOLUNTEERS.
Students Name *
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Parent/Guardian's Name *
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Parent/Guardian's Name *
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Phone Number *
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Phone Number *
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By checking the box and hitting submit I have read the Liability Release and the Rules for Refuge and agree to comply to them *
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