Stanardsville United Methodist Church Parental Consent And Liability Release Form

ADVERTISEMENT

Stanardsville United Methodist Church
Parental Consent and Liability Release Form
Participants Name ________________________________ Age _____ Birthdate________________
Address _________________________________________________________________________
City/State/Zip____________________________ Home Church _____________________________
Phone _________________________________ Email ____________________________________
Parent/Guardian ___________________________________________________________________
Work Phone __________________________________ Cell Phone _________________________
School Name _____________________________________________________ Grade ________
TO WHOM IT MAY CONCERN:
The undersigned do(es) hereby give permission for our (my) child ____________________________
(Participant) to attend and participate in Stanardsville United Methodist Church (SUMC) children or
youth ministry activities, events, and retreats until such time as notified.
LIABILITY RELEASE: In consideration of SUMC allowing the Participant to participate in children or
youth ministry activities, we (I), the undersigned, do hereby release, forever discharge and agree to
hold harmless SUMC, its directors, employees, volunteers and agents (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. We (I) the
parents(s) or legal guardian(s) of this Participant hereby grant our (my) permission for the Participant
to participate fully in youth ministry activities, including trips away from the church premises.
Furthermore, we (I) [and on behalf of our (my) minor Participants(s)] 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. Further, authorization and permission is hereby given
to said Church to prearrange any necessary transportation (within the limitations of church insurance
and the law), food and lodging for this Participant, pursuant to funding by parent/guardian and/or
scholarship. The undersigned further hereby agree 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: We (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 agree(s) to pay all costs and expenses incurred in connection with such medical
and dental service rendered to the aforementioned child or youth pursuant to this authorization.

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Legal
Go
Page of 2