Participation Form for Liberty University College For A Weekend (CFAW)

In order for you to participate in Liberty University’s CFAW, this form must be completed with your signature and the signature of your parent or guardian if you are under 18 years of age. Please turn this form in at check-in. If you have any questions, please call the Admissions Office at (800) 543-5317 Monday through Friday, 8 a.m. through 9 p.m., and Saturday, 10 a.m. through 6 p.m. EST, or email CFAW@liberty.edu.

In Case of Emergency

Father’s Name _____________________ Day Phone (____) _____________ Night Phone (____) ____________

Mother’s Name _____________________ Day Phone (____) _____________ Night Phone (____) ____________

Guardian’s Name ___________________ Day Phone (____) _____________ Night Phone (____) ____________

Medical Information

Are you allergic to any medication? ____ Yes ____No If yes, list out allergies ____________________________________ If you are required to take any medication, please describe the medicine, the frequency of dosage, and the amount:

Medical Authorization

I hereby give my son/daughter, _________________________, permission to participate in Liberty University’s CFAW and the associated activities of his/her choosing. In case of emergency, I give permission to the physician and/or hospital personnel selected by Liberty University personnel to hospitalize and secure proper treatment for my son/daughter as deemed necessary.

Photo Release

I hereby grant Liberty University permission to use images of me or my son/daughter captured during CFAW in print, web, electronic, and video formats, or in other official Liberty University print publications.

Assumption of Risk for Possible Injuries

My participation in various sporting or athletic activities during Liberty University’s CFAW has certain inherent risks which may affect me, including, but not limited to, serious neck and spinal injuries, complete or partial paralysis, brain damage, serious injuries to internal organs, bones, joints, ligaments, muscles, tendons, and other aspects of my musculoskeletal system, concussions, sprains, and other serious injury or impairment to other aspects of my body, and even death. I am voluntarily participating in the physical activities at CFAW that I choose with full knowledge, understanding, and appreciation of the risks involved, and hereby agree to assume any and all risks associated with such activities during CFAW. Having read the above statements regarding the risks involved, I voluntarily and willfully choose to take part and assume the risks attendant to my participation in physical activities at CFAW.

Risks Associated with Travel

CFAW may involve travel for certain participants who are provided transportation by Liberty University. Traveling has inherent risks. Specific risks involved with traveling include: getting lost or separated from the group or supervisors, contraction of communicable diseases, accidents, collision with other vehicles, whiplash, fires, explosions, defects in the vehicle or its equipment, blown out tires, derailments, overturning, breakdowns, running out of fuel, delays and being stranded, hazardous weather conditions, natural disasters, political unrest, kidnapping, criminal activity, terrorist activity, and conditions of locations not under the control of Liberty University. By using transportation provided by Liberty University, I acknowledge that I do so at my own risk and at my own discretion, and I assume all of these risks.

Signature of Participant _______________________________ Date _________

Signature of Parent/Guardian* __________________________ Date _________ *If a parent is not present, a youth leader must sign this form (required if you are under the age of 18).

email CFAW@liberty.edu web Liberty.edu

phone (800) 543-5317 fax (800) 542-2311

address 1971 University Boulevard Lynchburg, Va. 24515