Fillable Parental Consent, Medical, And Liability Release Form (Page 2 of 2) in pdf

For your information, we expect each student to conform to these rules of conduct:

No possession or use of alcohol, drugs, or tobacco

No students can drive

No fighting, weapons, fireworks, lighters, or explosives

No offensive or immodest clothing

No boys in girls’ sleeping quarters and no girls in boys’ sleeping quarters

Participation with the group is expected & encouraged

Respect property – yours, theirs, and ours

Respect one another, staff, and adult leaders

Respect and comply with event schedules and rules

Students who fail to comply with these expectations may be sent home at their parents’ expense.

I, the student, have read the rules of conduct, the above evaluation of my health, and permission to participate in youth group activities. I agree to abide by the

stated personal limitations and code of conduct.

Student’s Name (printed): ______________________________________________

Student signature: ____________________________________________________ Date: __________________________

Activities may include, but are not limited to: cookouts, boating, water skiing, swimming, basketball, games in the park, soccer, broomball, ice skating, volleyball, softball, baseball, camping,

skiing, snowboarding, hiking, concerts, Bible studies, miniature golf, hayrides, student conferences, rock climbing, lock‐ins, mission trips, service projects, small group trips, sleep‐overs, and

more.

PARENTAL CONSENT

This consent form gives permission to seek whatever medical attention is deemed necessary, and releases Inside Out Student Ministries and Chapel of the Hills

Church, and its staff of any liability against personal losses of named child. I/We the undersigned have legal custody of the student named above, a minor, and have

given our consent for him/her to attend events being organized by Inside Out Student Ministries and/or Chapel of the Hills Church.

I/We understand that there are inherent risks involved in any ministry or athletic event, and I/we hereby release the Church, its pastors, employees, agents, and

volunteer workers from any and all liability for any injury, loss, or damage to person or property that may occur during the course of my/our child’s involvement.

In the event that he/she is injured and requires the attention of a doctor, I/we consent to any reasonable medical treatment as deemed necessary by a licensed

physician. In the event treatment is required from a physician and/or hospital personnel designated by Inside Out Student Ministries and/or Chapel of the Hills

Church, I/we agree to hold such person free and harmless of any claims, demands, or suits for damages arising from the giving of such consent. I/We also

acknowledge that we will be ultimately responsible for the cost of any medical care should the cost of that medical care not be reimbursed by the health insurance

provider. Further, I/we affirm that the health insurance information provided above is accurate at this date and will, to the best of my/our knowledge, still be in force

for the student named above. I/we also agree to bring my/our child home at my/our own expense should they become ill or if deemed necessary by the student

ministries staff member.

Further, I/We give permission for my child’s picture or likeness to be included in videotapes, broadcast media, social media, print media and/or his/her name and

picture or likeness to be used in Inside Out Student Ministries and/or Chapel of the Hills materials.

Media Opt‐Out: I/We DO NOT CONSENT to my child’s picture or

likeness being included in videotapes, broadcast media, social

media, print media, and/or his/her name & picture or likeness to be

used in Inside Out Student Ministries and/or Chapel of the Hills

materials. Initials: _________Date: _______________________

I HAVE CAREFULLY READ THIS AGREEMENT AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS RELEASE OF LIABILITY AND AN

ASSUMPTION OF RISKS AND SIGN IT OF MY OWN FREE WILL.

Parent/guardian’s name (printed): __________________________________________________

Parent/guardian signature: ________________________________________________________

This Consent and Liability Release shall remain effective until revoked in writing and delivered to any officer, employee, or agent of Chapel of the Hills.

Executed this (date)______________ day of __________________(month), 20_______(year), at __________________________________(city), California

Inside Out Student Ministries / Chapel of the Hills Church

11120 Oro Vista Ave. Sunland CA 91040

(818) 352-1487

Pastor: Peter Scott

Youth Pastor: Jesse Ruggles