Youth Liability Waiver

Youth Liability Waiver
Full legal name of your child is required.
Full legal name of parent or guardian is required.
Street address where the child resides.
Name of the school your child attends.
Insurance Company Name
Full legal name of emergency contact.
Special medical needs or concerns (allergies, conditions, dietary needs, medications, etc.):
Other information leaders should know about the child or adult participant.
On occasion, Agape Christian Worship Center takes photographs or makes an audio or video recording of children involved in church/youth activities. I consent to the use of any such photos, audio, or video record of the one named above to be used, distributed or displayed as agents of the church see fit.
I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature.


5232 Fairview Avenue
Boise, ID 83706

Weekly Services
Sundays: 11:00am
7:00pm Zoom Bible Study