Indemnity Form

Parents/Guardian’s Consent for Youth Conference and Activity

at Cornerstone Church : Period 15 – 17 June 2023
I………………………………………… (ID …………………………..)
acknowledge and am aware that my minor child will attend a Youth
Conference and will therefore also participate in related youth activities at
Cornerstone Church, which Youth Conference has been arranged by
churches af liated to New Covenant Ministries International (NCMI) over the
period 15 – 17 June 2023 I am fully aware of the risk of youth activities
related to the attendance, hosting and presenting of a Youth Conference at
Cornerstone Church campus. In my capacity as legal guardian/parent of
…………………………………………., I hereby indemnify and agree to hold
harmless Cornerstone Church, it’s management, representatives, employees
and agents, including, but not limited to the Leaders, Deacons, Elders,
volunteer workers and any staff of Cornerstone Church as well as any of the
other churches participating and co-hosting this event, being af liated to
NCMI and then also, as far it is relevant, any representatives of NCMI directly,
participating in this event in any capacity, associated with the presenting and
hosting of the Youth Camp, against all claims, loss or damage to property,
injury, including but not limited to personal injury, arising from whatever
cause, including negligence of Cornerstone Church, it’s management,
representatives, employees and agents and other representatives as detailed
here above, either to myself or the herewith named minor child, in connection
with the Youth Conference and related youth activities at Cornerstone Church
campus, over the entire duration of the Youth Conference.
Personal Particulars
Name ________________________________________________
ID ________________________________________________
Tell/Cellular ________________________________________________
e-mail ________________________________________________
Name of Child:_________________________________________________

Signature (Parent/Guardian) Date

_________________________________ _________________
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 Addendum A
Medical Release
I (we), …………………………………………………………., understand that in
the event of medical treatment being required for the below mentioned child
during the period attending the Youth Conference at Cornerstone Church over
the period 15-17 June 2023, every effort will be made to contact me.
However, if I cannot be reached, I give my permission to Cornerstone Church,
it’s management, representatives, employees and agents, including, but not
limited to the Leaders, Deacons, Elders, volunteer workers and
any staff of The Crossing Church as well as any of the other churches
participating (as named in the Addendum A hereto) and co-hosting this event,
being af liated to NCMI and then also, as far it is relevant, any
representatives of NCMI direct, participating in this event in any capacity,
associated with the presenting and hosting of the Youth Camp, present at the
event, to procure medical treatment, including anaesthesia, for my child’s
wellbeing.

Medical aid scheme:…………………………………….

Medical aid number:……………………………………
Member’s name and Address: …………………………

Name of Child:

____________________________________________________________

Signature (Parent/Guardian) Date

_________________________________ _________________
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