P.O. Box 2399 | Road Town Tortola VG1110
British Virgin Islands
(284) 542-7000
admin@freedomimpact.org

Youth Impact Registration & Waiver

Registration

*Please Note: If you wish to register more than one Youth Impact participant, a new form must be filled out after submitting current form.*

Participant Information


Emergency Contact

Physician Information

Insurance Information


Food will be served during Youth Impact events.

  • I acknowledge it is my responsibility to inform Youth Impact in writing of any food allergies or dietary restrictions.
  • I understand that while reasonable efforts will be made to accommodate food allergies, Youth Impact, its leaders, and volunteers are not responsible for accidental exposure or reactions.

Permissions & Waivers

IF YOU ARE UNDER THE AGE OF 18, THE SIGNATURE OF PARENT OR GUARDIAN IS REQUIRED. IF YOU ARE 18 YEARS OR OLDER, YOUR OWN SIGNATURE IS REQUIRED.
Events, Food, Transportation: This waiver covers my child to participate in Youth Impact, which may include transportation and the consumption of food provided during events, activities, outings and community outreaches.

Photography Release: I grant permission for Youth Impact to use photographs or videos of my child for promotional purposes.

Medical Release: In an event of an emergency, I authorize Youth Impact to seek medical attention for my child.

I have read and agree to the terms and conditions outlined above.


Submit