EmailMe Form - 2026 Youth Ministries Houston Food Bank Trip

PARENT / GUARDIAN (PLEASE PRINT)

I, _________________________ *

YOUTH'S NAME#1 (PLEASE PRINT)

my child _______________________ *

Grade Level/Age

YOUTH’S NAME#2 (PLEASE PRINT)

my child _______________________

Grade Level/Age

YOUTH’S NAME#3 (PLEASE PRINT)

my child _______________________

Grade Level/Age

YOUTH’S NAME#4 (PLEASE PRINT)

my child _______________________

Grade Level/Age *

DATE: Tuesday, November 24, 2026
TIME: 11:30 AM – 5:00 PM

LOCATION: Houston Food Bank
535 Portwall St. Houston, Texas 77029

**TRANSPORTATION WILL BE PROVIDED! **
All youth attending the event must be transported by WORIC. No exceptions!

DROP OFF: 11:30 AM at the Zone Building
PICK-UP: 5:00 PM from the Zone Building

The deadline to register and complete your waiver is Monday, November 9, 2026. Thank you kindly!

Signature of Parent / Guardian *

Clear

Date Time

MM / DD / YYYY

Contact Number

### - ### - ####

Alternate Number

### - ### - ####

Email

I, my minor child, or a minor child under my legal guardianship (individually and collectively referred to as Participants), intend to participate in the following activity (“Activity”) of Word of Restoration International Church:

Select the appropriate selection to indicate your understanding of each paragraph below:

Assumption of Risk. Participants assume all responsibility for Participants’ own safety while participating in the Activity and assert that they are in good health and physical condition. Participants understand that the Activity may be physically demanding and may require physical exertion by Participants. Participants agree to immediately notify WORIC and withdraw from the Activity if their health or physical condition changes. Participants further understand that participation in the Activity is completely voluntary, and Participants assume the risk of any and all injuries that may occur to Participants as a result of participation in the Activity. *

Select the appropriate selection to indicate your understanding of each paragraph below:

Waiver and Release. Participants release and forever discharge and hold harmless Word of Restoration Christian Fellowship, Inc. and its directors, officers, employees, agents, attorneys, related entities, successors, and assigns (collectively, WORIC) from any and all liability, claims, and demands of any kind or nature, either in law or in equity, which exist now or in the future in connection with Participants’ participation in the Activity. Participants understand and agree that this Release discharges WORIC from any liability or claim that Participants may have against WORIC with respect to bodily injury, personal injury, illness, death, property damage, or any other harm that may result from Participants’ participation in the Activity. Participants expressly waive any right to a trial by judge or jury that Participants may otherwise have with regard to any claim or liability related to Participants’ participation in the Activity. *

Select the appropriate selection to indicate your understanding of each paragraph below:

Medical Treatment. Participants consent to receive emergency medical treatment in the event of illness or injury and release and forever discharge WORIC from any liability or claim whatsoever which arises or may later arise on account of any medical services rendered in connection with an emergency during Participants’ participation in the Activity. *

Select the appropriate selection to indicate your understanding of each paragraph below:

Photo and Media Release. Participants grant to WORIC all right, title, and interest in any and all photographs, images, video, or audio recordings of Participants or Participants’ likeness or voice made by WORIC in connection with the Activity. Participants understand and agree that they will not receive compensation for any use of such material. *

Select the appropriate selection to indicate your understanding of each paragraph below:

Broad Release Intended. Participants expressly agree that this Release is intended to be as broad and inclusive as permitted by the laws of the State of Texas and that this Release shall be governed by and interpreted in accordance with the laws of the State of Texas. Participants further agree that in the event any clause or provision of this Release is deemed invalid, the enforce-ability of the remaining provisions of this Release shall not be affected. *

ACKNOWLEDGEMENT
READ CAREFULLY BEFORE SIGNING

By my signature below, I acknowledge that I have read this release and waiver of liability in its entirety and, in consideration for the right of myself and my minor child or a minor child under my legal guardianship to participate in the Activity, I in good faith make the releases and waivers and assume the responsibilities contained herein. I acknowledge that I have had an opportunity to ask questions and consult with an attorney of my choosing, and that I freely agree to the terms expressed in return for participation in the Activity.

Participant’s Printed Name *

First Last

Age (if under 18)

Participant’s Signature if age 18 or older

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Date

MM / DD / YYYY

IF PARTICIPANT IS UNDER 18 OR UNDER LEGAL GUARDIANSHIP, PARENTS OR GUARDIANS MUST SIGN:

Parent/Guardian’s Printed Name *

Parent/Guardian’s Signature *

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Date *

MM / DD / YYYY

Additional Parent/Guardian’s Printed Name

Additional Parent/Guardian’s Signature

Clear

Date

MM / DD / YYYY

ACKNOWLEDGEMENT READ CAREFULLY BEFORE SIGNING

IF PARTICIPANT IS UNDER 18 OR UNDER LEGAL GUARDIANSHIP, PARENTS OR GUARDIANS MUST SIGN:

ACKNOWLEDGEMENT
READ CAREFULLY BEFORE SIGNING