Youth Permission and Medical Release Form

I hereby grant permission for my child(ren) to participate in the First Presbyterian Church Youth Ministries. Should any problems arise concerning the behavior of my child that would require them to return home prior to the end of the activity, I will pay for his or her return or arrange for their pick up. I, the undersigned parent or legal guardian, individually and as guardian of the child(ren) listed below, hereby release and discharge First Presbyterian Church, its employees, representatives, agents, servants, activity sponsors, chaperones, drivers (over the age of 18 years old), and any and all assigns thereof from all claims, actions, damages, expenses, and compensation whatsoever which may result from the participation of my child in activities sponsored by the First Presbyterian Church.

Youth Name #1 (5th-12 grader)(Required)

Youth Name #2 (5th-12th grader)

Youth Name #3 (5th-12th grader)

Youth Name #4 (5th-12th grader)

Medical Consent(Required)

I authorize the treatment, by a qualified and licensed medical doctor, of the minor listed above in the event of any medical emergency which in the opinion of the attending physician, is necessary and I/we cannot be reached after a reasonable effort has been made to secure my/our personal consent. Any medical expenses are the responsibility of the participant and their insurance carrier.

Yes

Medical Insurance Company Name(Required)

Medical Insurance Phone(Required)

Policy Number(Required)

Primary Care Physician and Practice(Required)

Emergency Contact #1 Name(Required)

Emergency Contact #1 Phone(Required)

Emergency Contact #2 Name(Required)

Emergency Contact #2 Phone(Required)

Consent(Required)

I recognize that First Presbyterian Church uses photographs and video images of events in our publicity materials such as the
church website, social media, newspapers, and newsletters.

I hereby grant permission for photo/video images of my child to be taken and used for such purposes

PG-13 Movies(Required)

There will be times throughout the year where the group may watch movies together. In regards to PG-13 movies:

Social Media Consent(Required)

Social Media and Communication: We believe there is importance in relationships that foster and encourage strong faith development. With this in mind, I give the church's approved adult mentors, staff, and volunteers permission to communicate with my child for the purpose of an invitation to large group events and encouragement via a variety of platforms, including social media, apps, phone, texting, and email.

Youth name and cell phone number

Parent Email(Required)

Parent Cell Phone for receiving YM Texts

Name of Parent/Guardian Completing This Form

DigitalSignature

By checking this box, I certify that I am the Parent/Guardian listed on this form and I grant permission as indicated herein.

Youth Permission and Medical Release Form

Youth Permission and Medical Release Form

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