Liability Waiver

The Pentecostal Assemblies of Canada, BC/Yukon District’s Youth Getaway Conference Release of Liability, Waiver of Claims, Assumption of Risks and Indemnity Agreement

Parent/Guardian Information

Parent/Guardian

First Name

Last Name

Parent/Guardian Phone

(###)

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Emergency Contact

First Name

Last Name

Emergency Contact Phone

(###)

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Participant's Church/Youth Group

Liability Form

I hereby authorise and acknowledge that my child will be participating in Youth Getaway (the Event) organized by The Pentecostal Assemblies of Canada, BC/Yukon District from May 2, 2025 – May 4, 2025. I understand that the Event will involve risks to my child arising out of his/her travelling and participating in various activities and events, including the use of inflatables and participating in a dodgeball tournament. These risks include, but are not limited to the following activities: Inflatables • The event will feature inflatables, including the Adrenaline Bootcamp Obstacle Course, Human Foosball and Hungry Hippo Chow Down. • Parents/guardians acknowledge that their child(ren) will use the inflatables during the conference. Inflatables Use Acknowledgement: • By signing this waiver, parents/guardians acknowledge that their child(ren) will use the inflatables at their own risk. Dodgeball Tournament: • The conference includes a Dodgeball Tournament as part of the activities. • Participants and parents/guardians are aware of the dodgeball tournament and its associated risks.

Terms and Conditions

I, the undersigned parent/guardian of the participant(s) named below, hereby agree to the following terms and conditions: Please write your initials next to all items to confirm your understanding and agreement.

Assumption of Risk

• I understand that participation in the Event involves inherent risks, including but not limited to physical injury and possibly death, property damage, and emotional distress. • I voluntarily assume, on behalf of me and my child, the full risk and responsibility for any injury, harm or death that my child may suffer arising in any way from my child’s travel to/from and participation in the Event.

Release and Waiver

• On my own behalf and on behalf of my child, I waive, to the full extent possible at law, any rights whatsoever that I and my child may have now or in the future against The Pentecostal Assemblies of Canada, BC/Yukon District, Participant’s Church/Youth Group [named above], its affiliated churches and their respective officers, directors, employees, organizers, leaders, volunteers, agents, and sponsors (the “Releasees”) as a result of the death or injury or damage to the my child or my child’s property arising from my child’s travel to/from or participation in the Event; • On my own behalf and on behalf of my child, I release and forever discharge it’s the Releasees from any and all actions, causes of actions, suits, claims and demands whatsoever that I or my child may have against any of the Releasees as a result of, arising out of or in any way connected with my child’s travel to/from or participation in the Event. • This waiver and release include claims related to negligence, gross negligence, breach of contract, or any other legal theory.

Medical Treatment Authorization

• I have disclosed any and all medical conditions and/or allergies from which my child may suffer. • In the event of an emergency, I authorize The Pentecostal Assemblies of Canada, BC/Yukon District, and Participant’s Church/Youth Group [named above], or its employees and volunteers to seek medical treatment for my child(ren) as necessary. • I agree to ensure that at all times my child is covered by medical insurance. • I understand that I will be responsible for any medical expenses incurred.

Photography and Media Release

• I grant permission for The Pentecostal Assemblies of Canada, BC/Yukon District and Participant’s Church/Youth Group [named above] to use photographs, videos, or other media featuring my child(ren) for promotional purposes.

Acknowledgment of Rules

• I have read and understood the Event rules and guidelines provided by The Pentecostal Assemblies of Canada, BC/Yukon District and Participant’s Church/Youth Group [named above] • I agree to ensure that my child(ren) comply with these rules.

Child #1 Details

Name

First Name

Last Name

Age

Medical Number

Allergies

Will your child be bringing medications with him/her?

Yes

If yes, please list

Child #2 Details

Name

First Name

Last Name

Age

Medical Number

Allergies

Will your child be bringing medications with him/her?

Yes

If yes, please list

Release and Indemnity

Having been made aware of the activities the registrant will be doing, I hereby consent to the registrant’s participation in the BC/Yukon PAOC’s Youth Getaway 2025 conference. I voluntarily release and forever discharge The Pentecostal Assemblies of Canada, BC/Yukon District, Participant’s Church/Youth Group [named above], and its affiliated churches and their respective officers, directors, employees, organizers, leaders, volunteers, agents, and sponsors (the “Releasees”) from any and all liability, claims, actions, or rights of action which are in any way related to the registrant’s travel to/from and participation in the conference activities. I agree to indemnify and hold the Releasees harmless from any and all costs or damages, including attorney fees, incurred in connection with the registrant’s participation in conference activities. I further agree not to sue, assert or otherwise maintain any claim or cause of action against any of the Releasees arising from or connected with the registrant’s participation in conference activities. By attending Youth Getaway 2025, you will be participating in an event where photography, video and audio recording may occur. Your attendance and participation in the event signifies your acceptance of this, and releases The Pentecostal Assemblies of Canada, BC/Yukon District and Participant’s Church/Youth Group [named above] from any liability, payment or royalties in connection with the capture, reproduction or distribution of the images, video or audio by The Pentecostal Assemblies of Canada, BC/Yukon District and Participant’s Church/Youth Group [named above] as it deems fit. In case of emergency, I understand every reasonable effort will be made to contact the parents or guardians of minor registrants. However, if the parents or guardians cannot be reached within a reasonable time period under the circumstances, or if I, the below signed registrant am 19 years of age or older, I hereby give The Pentecostal Assemblies of Canada, BC/Yukon District and Participant’s Church/Youth Group [named above] permission to act on my behalf in seeking and administering medical treatment in the event that such treatment is deemed necessary or advisable for the registrant’s health, safety and welfare. I release The Pentecostal Assemblies of Canada, BC/Yukon District and Participant’s Church/Youth Group [named above] from liability in acting on my behalf in this regard and rendering such medical treatment. I agree to submit any claims or causes of action regarding the enforceability of this waiver or any claim related to the subject matter herein to the Christian Coalition/mediation organization for binding resolution.

I have read and I have read and carefully understand this Release.

Signer's Name

First Name

Last Name

Signed On

YYYY

Liability Waiver

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