Please answer in detail if appicable or write N/A.

1. List any medical conditions your youth has (asthma, diabetes, epilepsy, etc.

2. List any allergies (drug/medicine, food, and/or environmental) and the severity and type of reaction.

3. Please explain any other pertinent information about the participant (i.e. physical, behavioral, or emotional) that would be important for the adult leaders to know.

List all medications your youth will take during any youth ministry trips, retreats or events. This includes any prescription, non-prescription medications, herbal supplements and vitamins. Any participant under the age of 18 is required to give ALL MEDICATIONS to the adult youth leader in their original containers with complete dispensing instructions before the start of the event. Youth are not permitted to carry any prescription or non-prescription medications and will be sent home at the parent/guardian's expense if they do.

Do you give permission for your youth to be given over-the-counter medication as needed and as directed on the label, to treat non-emergency medical conditions that do not require a doctor or hospital visit such as a minor headache, stomachache, or allergic reaction (i.e. Tylenol, Advil, Antacids, Benadryl) while at a youth ministry event?

The undersigned does hereby give permission for my child/youth , to attend and participate in any Montrose United Methodist Church children/youth ministry activities, events, retreats and childcare during the period of October 22, 2020 to September 1, 2022.

 

LIABILITY RELEASE: In consideration of Montrose United Methodist church allowing the Participant to participate in children/youth ministry (Sunday worship, Sunday meeting, Activities, Events, Retreats, Lock-Ins, Trips) and childcare(Quick care, PNO), I, the undersigned, do hereby release, forever discharge and agree to hold harmless Montrose United Methodist Church, its pastors, directors, employees, volunteers and teachers (collectively herein the “Church”) from any and all liability, claims or demands for accidental personal injury, sickness or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by the undersigned and the Participant while involved in the children/youth activities and childcare. I the parent or legal guardian of this Participant hereby grants my permission for the Participant to participate fully in children/youth ministry activities and childcare, including trips away from the church premises. Furthermore, I, on behalf of my minor Participant, hereby assume all risk of accidental personal injury, sickness, death, damage and expense as a result of participation in recreation and work activities involved therein. The undersigned further hereby agrees to hold harmless and indemnify said Church for any liability sustained by said Church as the result of the negligent, willful or intentional acts of said Participant, including expenses incurred attendant thereto.

 

MEDICAL TREATMENT PERMISSION: I authorize an adult, in whose care the minor has been entrusted, to consent to any emergency x-ray examination, anesthetic, medical, surgical or dental diagnosis or treatment and hospital care, to be rendered to the minor under the general or special supervision and on the advice of any physician or dentist licensed under the provisions of the Medical Practice Act on the medical staff of a licensed hospital or emergency care facility. The undersigned shall be liable and agrees to pay all costs and expenses incurred in connection with such medical and dental services rendered to the aforementioned child or youth pursuant to this authorization.

 

TRANSPORTATION PERMISSION: The undersigned does also hereby give permission for my child/youth to ride in any vehicle driven by an approved and licensed ADULT chaperone while attending and participating in activities sponsored by Montrose United Methodist Church. My child/youth and I understand that SEAT BELTS MUST BE WORN AT ALL TIMES during transportation.

I agree that Montrose United Methodist Church may photograph and record my child/dependent’s likeness and activities (Images)[1] during church-related activities. I grant the following rights to Montrose United Methodist Church: permission to use and re-use, publish and re-publish, and modify or alter the Image(s) taken during the shoot. Use of the Images for editorial, commercial, trade, advertising, and any other purpose may be done in any medium now existing or subsequently developed, on the church website and on the Internet, and worldwide in perpetuity for the purposes stated above.

 

I waive my right to inspect or approve any editorial text or copy that is used in connection with the Images and release and discharge Montrose United Methodist Church from any and all claims arising out of use of the Images for the purposes described above, including any claims for libel, invasion of privacy, or other tortuous act.

 

I have read the foregoing. I fully understand its contents, understand that this agreement does not expire, and confirm my agreement by signing below. I am over the age of 21 and have legal capacity to sign the release.

The following rules and guidelines are equally binding on adult leaders/chaperones and youth.

 

Non-Negotiable Rules

Any participant failing to abide by these rules will be sent home immediately at personal/family expense.

• No use of illicit drugs or alcohol

• Presence at and full participation in all group activities, including adherence to curfews and other time-related instructions

• No sexual misconduct (defined as exposure, touching, or inappropriate reference to body areas normally covered by undergarments)

• Must be in assigned rooms by designated time

• Coed visitation only in assigned community room

• Smoking and the use of tobacco or vape products are not allowed to, from, or during any trip.

• Will not break any American laws in the United States or any other country.

Guidelines for Living in Christian Community

• Adults and youth will be equally responsible for performing assigned tasks in a timely and cooperative manner.

• Participants will be respectful, encouraging, and will maintain a positive attitude toward others at all times, recognizing Christ’s presence in each other.

• Participants will be respectful of both common living spaces and the property of others.

• Participants will avoid the use of foul language, cursing, or any speech (including “humor”) which puts down, makes fun of, or stereotypes other persons or groups.

• Sleeping areas for males and females will be separate.

 

Youth Participant’s (or Adult Leader’s) Statement: By signing this form, I pledge to honor God and respect others during this activity by following the rules and guidelines printed above. I understand that I cannot participate in the activity unless this completed form is on file.

Parent/Guardian's Statement:

By signing this form, I agree to support the Covenant of COmmunity Expectations printed above, and will accept responsibility for the payment of my child's return transportation should he/she break one of the non-negotiable rules.