Youth Huddle Permission Form

This survey is optional. It includes several questions about your current feelings about your youth returning to regular church youth activities as local government lifts its ban on public gatherings. Therefore, the information gathered will allow us as a ministry to best serve you, your youth, and our church.

Pearlside Church

Travel/Excursion/Event Permission Form Event: Pearlside Church - Youth Regathering Location: Main Campus (98-771 Oihana Place, Aiea, HI 96701) Purpose: Our Youth ministry will be hosting events during service at Pearlside church and outside of service times to have the opportunity to have fun, stay connected, and be a blessing to one another. Requirements: Online permission form and online consent waiver MUST be filled out by parent/guardian prior to the outing date. Transportation: Youth are expected to provide their own transportation unless otherwise noticed. Contact Person(s): Youth Pastor - Chad Udani (808-228-6875) Middle School Director - Henric Razon (808-429-4079) Campus Minister - Edwin Izumigawa (808-342-7500) Campus Minister - Melody Lagutan (808-391-4703) For more information please contact the church office @ 808-484-0061 or email at: youth@pearlside.org

CHILD #1/MINOR'S INFORMATION

Child #1/Minor's Name

We hereby give our child/minor (insert child's name below) permission to attend the following excursion/event conducted, sponsored, or attended by Pearlside Church.

First Name

Last Name

Child #1's School Campus

Child #1's Age

Child #1's Contact Info (If available)

Child #1/minor’s allergies or any medical conditions that we should be aware of:

CHILD #2/MINOR'S INFORMATION

Child #2/Minor's Name

We hereby give our child/minor (insert child's name below) permission to attend the following excursion/event conducted, sponsored, or attended by Pearlside Church.

First Name

Last Name

Child #2's School Campus

Child #2's Age

Child #2's Contact Info (If available)

Child #2/minor’s allergies or any medical conditions that we should be aware of:

CHILD #3/MINOR'S INFORMATION

Child #3/Minor's Name

We hereby give our child/minor (insert child's name below) permission to attend the following excursion/event conducted, sponsored, or attended by Pearlside Church.

First Name

Last Name

Child #3's School Campus

Child #3's Age

Child #3's Contact Info (If available)

Child #3/minor’s allergies or any medical conditions that we should be aware of:

Release Of All Claims Indemnification

1. In consideration of permission granted to (minor mentioned above) hereinafter the “participant” by Pearlside Church to participate in the activity listed above, the undersigned hereby releases, discharges, and covenants not to sue Pearlside Church, Every Nation Ministries, it’s agents, employees and officers from all actions, causes of action, damages, claims, or demands which the undersigned and or participant ever had, or now has, or may have, or which the undersigned and/or participant’s heir, executors, administrators, or assigns may have, or claim to have against Pearlside Church, it’s agents, employees, and officers for all personal injuries and property damage, known or unknown, which the undersigned and/or participant have or may incur by participating in the above described activity. 2. My youth will follow the Center for Disease Control (CDC) and local health district guidelines and Pearlside Church Policies and procedures to reduce the spread of Covid-19 and will agree to utilize a face mask to reduce the risk of exposure to my youth and others. 3. I understand if my youth fails to comply with these written instructions or verbal instructions from Pearlside Church staff, Pearlside will not be held liable for any event of injury or illness of the participant. We will ask for a parent/legal guardian to pick up your youth. 4. As additional consideration for permission to participate in the above-described activity the undersigned agrees to indemnify, save, and hold harmless the Church, it’s agents, employees, and officers from any and all deaths, injuries, losses and damages to persons or property, and any and all claims, demands, suits, actions and liability therefore, caused by the participant’s participation in the above activity. 5. The undersigned agrees to authorize such medical treatment as necessary in the event of illness or injury to said participant. 6. If applicable, the undersigned as a parent(s) or legal guardian(s) of the participant represents Pearside Church, that facts herein concerning the participant are true. The undersigned hereby gives you permission for the participant to participate in the above-described activity, and further, in consideration of permission granted by Pearlside Church to participate in the above-described activity. Agree individually and on behalf of the participant to the terms of the above Release of all Claims and Indemnification. 7. The undersigned has received and read the informed Consent and Assumption of the Risk for the activity listed on the previous page and knows the contents thereof. 8. We further grant permission for our youth//minor to travel by Church or private vehicle to and from to the above destination or events. Temporarily, service transportation will be unavailable during this Covid-19 time until further notice

Agreement of Parent/Legal Guardian

First Name

Last Name

Relationship to Chil(dren)

Date Signed

YYYY

Parent/Legal Guardian's Cell Phone Number

(###)

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Parent/Legal Guardian's Work Phone Number

(###)

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