Palouse Federated Church Quarterly United Youth Group Waivers

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This permission slip is valided for all quarterly United Youth Group events. 
Youth Information

 
 
 
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Parent/ Guardian Information

 
 
 
 
Emergency Contact

 
 
 

The undersigned does hereby give permission for my child ____________________________ (“Participant”), to attend and participate in the Palouse Federated Church youth ministry activity (activity, event, retreat, lock-in, trip, etc.) identified above.

 

LIABILITY RELEASE: In consideration of Palouse Federated Church allowing the Participant to participate in the aforementioned youth ministry activity, (activity, event, retreat, lock-in, trip, etc.), I, the undersigned, do hereby release, forever discharge and agree to hold harmless Palouse Federated Church, its pastors, directors, employees, volunteers and teachers (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 youth activities. I, the parent or legal guardian, of this Participant hereby grant my permission for the Participant to participate fully in the youth ministry activity, including trips away from the church premises. Furthermore, I, on behalf of my minor Participant, 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. The undersigned further hereby agrees 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: I authorize an adult/volunteer, 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 a physician or dentist or the medical staff of a licensed hospital or emergency care facility. I hereby release and forever discharge Palouse Federated Church from any claim whatsoever which arises or may hereafter arise on account of any first-aid treatment or other medical services rendered in connection with an emergency during the Participant’s participation in the youth activity.  The undersigned shall be liable and agrees to pay all costs and expenses incurred in connection with such medical and dental services rendered to the aforementioned child or youth pursuant to this authorization.


 


EARLY RETURN HOME POLICY: Should it be necessary for my child to return home due to medical reasons, disciplinary action or otherwise, the undersigned shall assume all transportation costs and responsibility.


 


TRANSPORTATION PERMISSION: The undersigned does also hereby give permission for my child to ride in any vehicle driven by an approved and licensed ADULT chaperone while attending and participating in activities sponsored by Palouse Federated Church. My child and I understand that SEAT BELTS MUST BE WORN AT ALL TIMES during transportation.


 


PHOTOGRAPHIC RELEASE: I agree that Palouse Federated Church may photograph and record my child/dependent’s likeness and activities (Images)[1] during church-related activities. I grant the following rights to Palouse Federated Church: permission to use and re-use, publish and re-publish, and modify or alter the Image(s) taken of the Participant. Use of the Images for editorial, commercial, trade, advertising, and any other purpose may be done in any medium now existing or subsequently developed, on the church Web site and on the Internet, and worldwide in perpetuity for the purposes stated above.






[1] Image means all photographs, images, film, video or audio recordings taken of the participant.



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By putting your name here you are giving Palouse Federated Church permission to take your student. 
 
 
 

Description

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