IGLESIA EVANGELICA UNIDA DE CRISTO

National Unida Youth

Unida Christian Center, Biga, Silang, Cavite

PARENTAL CONSENT/WAIVER

Please complete and return to the National Youth Officers at your earliest convenience on or
before December 15, 2012.

Permission is granted for my son/daughter to participate in the Christmas Conference and

Leadership Training to be held on December 26-31, 2012 at Carcar, Cebu City.

Participant’s Name: _________________________________________

Local Church/District: __________________________________________
Local Pastor: __________________________________________
Address: __________________________________________
Contact Number/s: __________________________________________

I/We, hereby acknowledge that sufficient information has been provided by the National Youth
Conference Committee, with respect to the planned activity, duration, location, method of
transportation, participants and supervision.

I/We, hereby acknowledge that certain RISKS OF INJURY are inherent to participate in the said
activity. These types of injuries may be minor or serious and may result from one’s actions, or
the actions or inaction of others, or a combination of both.

I/We, in consideration of my/our son’s/daughter’s participation in the said activity, agree to

defend, hold harmless, indemnify and release the National Youth Officers or their members or
representatives, and volunteers from and against any and all claims, demands, actions, or causes
of action of any sort on account of damage to personal property, personal injury, or death which
may result from his/her participation in the aforesaid activity. This release includes all claims
based on circumstances beyond their control, but expressly does not include claims based on
their intentional misconduct or recklessness. I/We understand that by agreeing to this clause
I/We am/are releasing claims and giving up substantial rights, including my/our right to sue.

I/We understand that the Rules and Regulations established for the conference is designed for the
safety and protection of the participants and hereby undertake to inform my/our son/daughter to
abide by these rules and regulations.

I/We declare having read and understood the above Parental Consent/Waiver in its entirety and
hereby consent to allow my/our child to participate, acknowledging all of the foregoing.

___________________________ ____________________________________
Signature over printed name of Signature of the Participant
Parent/Guardian

Conforme:

________________________________
Signature over printed name of the
Local Church Pastor/District Superintendent

___________________________
Date