Youth Escape Room Event

Family Info

Name of First Minor

Name of Second Minor (if applicable)

Friend of:

Address

Name of Parent or Guardian

Address (if different than minor's)

Parent or Guardian's Phone

Additional Phone

Emergency Contacts

Emergency Contact (other than parent or guardian)

Emergency Phone

Medical Release

Permission and Release: I give permission for my child to participate in all CAC Youth activities. In the event he/she is injured, I waive and release all rights to any claim for damages against the sponsor or its representatives. I further agree that any claim or dispute arising from or related to this agreement shall be settled by mediation and, if necessary, legally binding arbitration, in accordance with the Rules of the Institute for Christian Conciliation; judgment upon an arbitration award may be entered in any court otherwise having jurisdiction. Medical Release: In the event my child suffers sudden illness, accident, or injury and neither parents nor guardians can be contacted, I give permission for any emergency treatment that is deemed necessary by a licensed physician.

I have read the above statement and hereby give my permission.

Yes

Family Physician

Physician's Phone

Medical insurance company and policy #

Current medical information (diabetes, allergies, etc.)

This address will receive a confirmation email

Description

Saturday, February 8th @ 11am

We are going to meet at the church at 11am and head to Idaho Falls and go to Idaho Escape Room. We will return to the church later in the evening.

Please bring $10 for treats after the Escape Room.

Youth Escape Room Event

Description

Please Fix the Following