GATEWAY YOUTH WAIVER/RELEASE

TO BE FILLED OUT BY PARENT/GUARDIAN Waiver/Release for 2025, including, but not limited to these events: -Youth For the Nations Camp in Dallas, Texas (June 2025) -Various youth group outings, like going to CiCi's Pizza in Beaumont, bowling, laser tag, etc. *A parent/guardian and the student must complete this form. *Please check each section to confirm compliance.

STUDENT INFORMATION

One form per child
Date

EMERGENCY CONTACT

MEDICAL INFORMATION

PHYSICIAN INFORMATION

Type "None" for no insurance.

Type "None" for no insurance/self-pay

WAIVER AND RELEASE OF LIABILITY | PARENT/GUARDIAN MUST SIGN BELOW

*READ BEFORE SIGNING

In consideration of being allowed to participate in any way in GATEWAY CHURCH'S YOUTH MINISTRY, related events and activities, the undersigned acknowledges, appreciates, and agrees that:

The risk of injury from the activities involved in this program is significant, including the potential for permanent paralysis and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and,

I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation; and,

I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately; and,

I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS GATEWAY CHURCH, their directors, officers, officials, agents, volunteers and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event (“RELEASEES”),WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law.

I hereby grant GATEWAY CHURCH permission to use my likeness and my child's likeness in a photograph, video, or other digital media (“photo”) in any and all of its publications, including web-based publications, without payment or other consideration.

I understand and agree that all photos will become the property of GATEWAY CHURCH and will not be returned.

I hereby irrevocably authorize GATEWAY CHURCH to edit, alter, copy, exhibit, publish, or distribute these photos for any lawful purpose. In addition, I waive any right to inspect or approve the finished product wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photo.

I hereby hold harmless, release, and forever discharge GATEWAY CHURCH from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.

I HAVE READ AND UNDERSTAND THE ABOVE PHOTO RELEASE. I AFFIRM THAT I AM AT LEAST 18 YEARS OF AGE, OR, IF I AM UNDER 18 YEARS OF AGE, I HAVE OBTAINED THE REQUIRED CONSENT OF MY PARENTS/GUARDIANS AS EVIDENCED BY THEIR SIGNATURES BELOW.

By attending this event you recognize you may come into contact with someone who has COVID-19 and YOU MAY CONTRACT THE VIRUS yourself.

You also agree that you hold GATEWAY CHURCH, it's staff and volunteers HARMLESS if you contract COVID-19 or any other disease while attending this event.

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

Being the parent or legal guardian of the minor child, I do consent to any medical, surgical, x-ray, anesthetic, or dental treatment that may be deemed necessary for my minor child. I understand that efforts will be made to contact me prior to treatment but, in the event I cannot be reached in an emergency, I give permission to the activity leader to make the decisions necessary for treatment. Should there be no activity leader available, I give permission to the attending physician to treat my minor child. As parent or legal guardian, I understand that I am responsible for the health care decisions of my minor child and agree that my insurance plan is the primary plan to pay for the medical, dental, or hospital care or treatment that is given to my minor child. If I do not provide medical insurance for my minor child, I accept full responsibility for all medical payments regarding his/her medical care. Any insurance policy of the church or organization sponsoring this event will be used as the secondary coverage.

By applying my electronic signature to this agreement, I agree that my electronic signature is the legally binding equivalent of my handwritten signature on paper. The parties acknowledge and agree that this Waiver/Release may be executed by electronic signature, which shall be considered as an original signature for all purposes and shall have the same force and effect as an original signature. Without limitation, “electronic signature” shall include faxed versions of an original signature or electronically scanned and transmitted versions (e.g., via pdf) of an original signature.

A parent or legal guardian must sign this agreement on behalf of any minor participant under the age of 18. By electronically signing this agreement, I represent that I have the authority to sign and enter into this agreement on behalf of the minor(s) listed above.

STUDENT CODE OF CONDUCT >>STUDENT AND PARENT/GUARDIAN MUST SIGN BELOW<<

*READ BEFORE SIGNING

Students are expected to act in accordance with established Christian values and behavior patterns. In addition, the rules of Gateway Church as stated in this set of guidelines must be adhered to for the mutual benefit of all. One of Gateway’s most important goals is to facilitate the growth and development of Christian character in line with Biblical principles. It is expected that Gateway Church students act in a manner that brings glory to Christ in their behavior and attitudes. Therefore, each student is expected to:

• Abstain from any behavior that is considered detrimental to Christian character and witness including; drunkenness, stealing, slanderous or profane language, dishonesty, occult practices, relational inappropriateness and sexual immorality.

• Avoid attitudes and behavior that disrupts the unity and health of the Gateway Church youth ministry.

• Show respect and consideration for other members of the group and their property, including those outside of our group.

• Show respect for staff and adult volunteers and co-operate with the aims and endeavors of Gateway Church.

• Abstain from public displays of affection while at church functions. This includes “hanging on” someone, front hugging, hand-holding, kissing, sharing a seat, or other obviously “romantic” behavior.

• When attending youth events, students must stay in groups of at least two. Any group with one girl and one boy must find another student to accompany them. Boys and girls should NEVER be alone together.

• At no time will foul language or behavior that is disrespectful or rude to other youth members or to those in authority over the group be tolerated. This includes church staff, chaperones, parents, and those involved in the operation of whichever location/event Gateway Youth is attending.

Gateway Church aims to provide the framework and support needed to bring personal growth. If, however, students do find that they are genuinely struggling with such issues, we advise they speak with Gateway Church staff and allow them to bring guidance, counsel and correction to the situation. Any behavior that disregards the Student Code of Conduct or compromises the welfare of other students will result in his/her parents being called to remove their student from the event.

By signing, you acknowledge that you have read the Youth Code of Conduct and understand that any behavior that disregards the Youth Code of Conduct or compromises the welfare of other students will result in your parent/guardian being called to remove you from the event.

By signing, you acknowledge that you and your child have read the Student Code of Conduct and understand that any behavior that disregards the Student Code of Conduct or compromises the welfare of other students will result in you being called to remove your student from the event.

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