Youth 2015 Medical Release Form - Code Of Conduct printable pdf download

Youth 2015 Medical Release Form & Code of Conduct

Attention Group Leaders:

Please retain one copy of each participant’s Medical Release for your files and submit one into

Youth 2015 through the registration site. Participants must submit a release form to participate.

Medical History:

Participant Name __________________________________ Address _______________________________________________________________________________

Father/Guardian’s Name _______________________________

Phone # __________________ Work # ____________________

Mother/Guardian’s Name _______________________________

Phone # __________________ Work # ____________________

Other Contact Person__________________________________

Phone # ________________________________

Family Physician ______________________________________

Phone # ____________________________

Health Insurance Information

Carrier_________________________

Plan #_____________

Policy # _____________________________

Date of last tetanus booster__________ Allergies ____________ Insect Sting ____________ Food/Drug ______________________________________

Is your son/daughter under the care of a physician for a medical problem? __ Yes __ No

If yes, please explain _____________________________________________________________________

Is your son/daughter taking medication prescribed by a physician? __ Yes __ No

If yes, please explain _____________________________________________________________________

Other information an attending physician needs to be aware of:_______________________________________________

_____________________________________________________________________________________________________________________________

List any over-the-counter medications you do not wish dispensed to your child for treatment of minor ailments or injuries:

Code of Conduct:

As a representative of Christ and of the United Methodist Church, we, the participants of Youth 2015, take seriously our

responsibility to care for one another. This code represents affirmation of our concern for the well being of the total community.

We covenant with each other to insure the safety of all, to make our time together most meaningful, and to care for the facility

which we share.

Anything considered illegal under civil and criminal law in

Florida is illegal for participants of Youth 2015. This includes

We will respect the person, equipment and property of

drug possession and use, alcohol consumption and

others as well as the public and private properties (hotel and

possession by a minor and alcohol consumption on state

conference rooms, etc) we will be using during Youth 2015.

property, possession of firearms, weapons or fireworks, etc.

(This should be taken into consideration when considering

Tobacco use is illegal for those under 18. Smoking is

practical jokes, water fights, use of shaving cream, etc. Do no

discouraged for adults but will be permitted in outdoor

harm to others)

areas.

Any accidental damage to the hotel or convention area

All groups must adhere to Safe Sanctuary policies. In

property will be billed to the local church and will be the

addition to the 5:1 youth to adult ratio, all groups with both

responsibility of the persons who caused the damage.

male and female participants must bring at least one

Intentional damage is subject to additional penalties.

leader/chaperone (age 21+) of each gender. Each group is

encouraged to have at least one leader/chaperone that is 25

I understand that violations of this covenant and/or other

years old or older.

inappropriate behavior could require disciplinary action for

Dress should be appropriate for a co-ed Christian

youth and adults. Decisions about appropriate disciplinary action

environment.

will be made by adult group leaders and the Youth 2015 Design

All participants are expected to participate in the event in

Team. Youth 2015 reserves the right to call parents or to dismiss

full and be at designated places at all times.

any person who breaks this code of conduct.

Visitation between males and females in hotel rooms is

prohibited unless directly supervised in a group setting by

the group’s responsible adult.

I give my permission for such diagnostic and therapeutic procedures, as may be deemed necessary ( for my son/daughter if under

18) by qualified medical care providers, hospitals or physicians while my son/daughter is in route to or from or in attendance at

Youth 2015. I also understand & agree to abide by the Code of Conduct for Youth 2015:

Participant Signature & date ______________________________________________________________________________

Parent/Guardian Signature (if under 18) & date_______________________________________________________________

Youth 2015 Medical Release Form - Code Of Conduct

Related Articles

Related forms

Related Categories