Activity Permission, Release and Medical Power of Attorney for NHY (New Hope Youth)

Agree and Acknowledge

I understand and acknowledge that if I proceed to register on line and to sign the waiver electronically that such electronic registration and electronically signed Waiver document will be valid and enforced in the same manner as a hand-signed document that exists in physical form and that a record or signature may not be denied legal effect or enforceability under law solely because it is in electronic form.

Basic Information

Use parent or guardian information if under 18

Contact Information

Use parent or guardian information if under 18

Student Medical Information
Minor Information

Enter the information for the children for which you are responsible for:

1. I, the lawful parent or guardian of the previously mentioned minor, give permission for my child to participate in any and all activities including but not limited to Winter Jam, Camps, Beach Trips, Retreats, etc. and indemnify the International Church of the Foursquare Gospel and New Hope Foursquare Church ("Church") and its directors, officers, council, agents, representatives, volunteers, and employees from any and all liability, claims, judgments, cost or expenses, including attorney fees, arising out of any damage, injury or illness incurred or caused by my child while participating in or traveling to or from the activity, or otherwise in Church custody. I understand the risks in these activities, including the possibility of unforeseen hazards, serious injury or death. I certify my child is able to participate in the activity.

2. I agree to instruct my child to cooperate with the Church and its representatives in charge of the activity and understand my child may be prohibited from participating and/or sent home for any failure to follow the rules established by the Church.

3. I appoint Church representatives who are acting as leaders, or designated by such leaders, as my attorney in fact to act for me in my name and my behalf, in any way that I could act if I were personally present, with respect to the following matters if any injury, illness or medical emergency occurs during the activity, related travel or while my child is in Church custody. a. To give any and all consents and authorizations to any physician, dentist, hospital or other persons or institutions pertaining to any emergency transportation, medications, medical or dental treatments, diagnostic or surgical procedures or any other emergency actions as our medical attorney-in-fact shall deem necessary or appropriate for the best interest of the child. b. I understand the Church will make a reasonable attempt to contact me as soon as possible in the event of a medical emergency involving my child.

4. I agree that the Church may use my child’s and/or my own name, voice, portrait, photograph or image for promotional, website, office or any other church related purposes. These may be used in any broadcast, telecast, digital or print medium, including video images, photographs, pictures or renderings, audio recordings, or other likenesses, in combination or alone. I will notify the Church immediately of any change in the information presented and agree it is valid until revoked in writing by me. I have carefully read this statement, and my signature acknowledges that I fully understand the content and meaning.


By entering my name below and clicking the “Submit Waiver” button below, I indicate my acceptance and delivery of this waiver and release. I acknowledge that I have been given an opportunity to prevent or correct any error in connection with this waiver form. If I have submitted this waiver form in error, I will immediately notify you of the error, revoke my signature as instructed, and refrain from participating in any event or activity to which the waiver applies.