CFC Youth for Family and Life

A Youth Ministry of Couples For Christ Foundation for Family and Life (CFCFFL)
Central Cluster, New Jersey

CFC YOUTH for Family and Life (CAMP) Retreat – April 15, 16, & 17,
2011

PARENT CONSENT/WAIVER RELEASE OF LIABILITY & MEDICAL

AUTHORIZATION

For all YOUTH for FAMILY and LIFE (YFL) (CAMP) Retreat Participants (one for
each son/daughter)
I/we, , parent or legal guardian of

________________, _______ (NAME and AGE of participant), hereby give permission for my
child to participate in activities conducted by Couples For Christ Foundation for Family and
Life (CFC FFL) NJ during the YFL CAMP to be held at (CFC-FFL Home) 411 RUTGERS AVE,
HILLSIDE, NJ
I/We understand that all precautionary measures will be taken care of by the CFC YFL, New
Jersey and their Ministries, organizers and leaders to ensure safety of all the participants.
However in cases of accidents or untoward and un-suspected incidents that may cause harm, I
freely make the statements below:
CFC FFL, New Jersey and its Ministries, organizers and leaders are, therefore, fully
absolved and released from any and all responsibility and/or liability that may directly or
indirectly arise from or be incidental to the Participant’s attendance, participation and
involvement in any and all activities within the scope of the YFL Camp. I understand and agree
that by signing this Parent Consent/Waiver/Release of Liability, I am assuming full
responsibility and I am agreeing to release, indemnify and hold CFC FFL, New Jersey, its
Ministries, their organizers and leaders free and harmless from any liability, costs or
damages to any person/s and/or property caused by, arising out of, or incidental to, the
Participant’s attendance, participation and involvement in this Youth for Family and Life
Camp. I understand that this Consent/Waiver/Release/Release of Liability will be binding on
me, my spouse, my heirs, my personal representatives, my assigns, my children, and any
guardian ad litem for said children.
Further, I/We hereby grant permission to YFL Parent Servants, to perform any medical or
surgical consultation deemed advisable, and any hospital or physician to render the above-
named CFC YFL Camp participant any medical and surgical treatment that they deem
necessary.
I/we understand that all possible effort will be made to inform me/us in case of such
treatment.
Youth Name: _____________ DOB: ________________
Age:_________
E-mail address: Cell Ph#_______________ Home
Ph#_______________
Address:

Father name:____________________________________ Mother’s name:

__________________________

Father’s E-mail: Mother’s email address:

___________________

Father’s cell phone: Mother’s cell phone:

If Parents cannot be reached in case of emergency, please provide the names and phone
numbers of at least two others whom we may contact:

1) 2)
______