Stanardsville United Methodist Church Parental Consent And Liability Release Form printable pdf download

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.

Stanardsville United Methodist Church Parental Consent And Liability Release Form