Stanardsville United Methodist Church Parental Consent And Liability Release Form (Page 2 of 2) in pdf

Stanardsville United Methodist Church Parental Consent And Liability Release Form Page 2

TRANSPORTATION PERMISSION: The undersigned does also hereby give permission for our (my)

child/youth to ride in any vehicle driven by an approved ADULT chaperone while attending and

participating in activities sponsored by SUMC. My child/youth and I understand that SEAT BELTS

SHALL BE WORN AT ALL TIMES during transportation.

Parent(s)/Guardian(s) signature: ______________________________________________________

Date ___________________________________

PHOTO RELEASE; By my signature below and consent by checking Yes or No, permission is given

for the Church, without further consideration or compensation, to use any photos taken of said

child/youth during SUMC activities. Such photos may be used in a variety of media outlets. The

names and other identifying information of the children will NOT be disclosed. I understand that

SUMC remains the sole owner of such photographs and that no financial profit will be made by it or

the photographers by my image without my (our) written consent. Yes _____ No _____

Medical Insurance: Yes _____ No _____ Insurance Company _____________________________

Policy/Group ID#____________________________

Emergency Contacts (in case parent(s) cannot be reached:

Name _________________________________________ Phone Number ____________________

Allergies or Medical Conditions:

________________________________________________________________________________

Names of responsible parties that children may be released to other than parents:

________________________________________________________________________________

Parent(s)/Guardian(s) signature: ______________________________________________________

Date ___________________________________

Stanardsville United Methodist Church Parental Consent And Liability Release Form Page 2