Please fill this out prior to our first youth night (September 17 for Jr High or September 19 for Sr High)

While every reasonable precaution is taken for the safety and health of your student, we understand that accidents, illness, or other unforeseen circumstances may occur. By granting consent below, you acknowledge and agree to the following: Assumption of Risk: I understand that participation in MVMNT Students activities at LPC may include, but is not limited to, games, sports, transportation, and other physical activities. I acknowledge that there are inherent risks involved and accept responsibility for my child’s participation. Release of Liability: To the fullest extent permitted by law, I release and hold harmless Listowel Pentecostal Church, its staff, volunteers, and representatives from any and all claims, demands, actions, or causes of action arising out of my child’s participation in these activities. Medical Consent: In the event of sickness or accident, I authorize LPC, its staff, or volunteers to secure such medical attention as may be deemed necessary. Should my child require medication, X-rays, hospitalization, anesthesia, or surgery, I consent to such treatment and understand that every effort will be made to contact me immediately. Insurance Requirement: I confirm that my child is covered by Provincial Health Insurance or equivalent medical insurance. Confidentiality: I understand that the information provided in this form will remain private and confidential, unless required in the event of an emergency. Off-Site Events: I understand that any event held off church property will require separate documentation and permission. Student Conduct: I acknowledge that my child is expected to follow all safety instructions and behave respectfully. LPC reserves the right to dismiss any student whose behavior is deemed unsafe or disruptive.