First United Methodist Church of Titusville
    Children and Youth Waiver Form

    Waiver MUST be filled out by legal guardian*
    Notarized waiver is needed for weekly off campus and overnight events

    Student Information

    Student Health History

    Current Medications (list prescription, Over the counter & herbal)

    Parent/Guardian Information​

    Must be filled out by legal parent/guardian of the child

    Waiver

    FUMC is not responsible for the loss or theft of personal belongings.
    Misconduct may result in transportation home from an activity. A dismissed for a disciplinary reason will not receive a refund of the activity fee.

    I understand and authorize that my child's image may be photographed or filmed and used in video presentations, Children/youth ministry Facebook, and First United Methodist website.
    I hereby take the following action for my child, myself, my executors, administrators, heir, next of kin, successors and assigns: A) I waive, release, and discharge from any and all claims or liabilities for death or personal injury damages of any kind, which arise out of or relate to my child’s participation in FUMC’s activities, the following person, or entities: FUMC, it’s Senior Pastor and Associate Pastors, Elders, employees, volunteers, representatives, subcontractors and agents of any of the above: B) I agree not to sue any of the persons or entities mentioned above for any of the claims or liabilities that I have waived, released or discharged herein except in the case of gross negligence in the part of FUMC, FUMC’s staff or volunteers and: C) I indemnify and hold harmless the person or entities mentioned above from any claims made or liabilities assessed against them as a result of my child’s actions. I hereby assume the risks of my child participating in all FUMC ministries activities.
    Max file size: 20MB
For any problems contact Lauren at [email protected]