Permission Form:
The parent(s)/legal guardian(s) recognizes that ___________________________________ (enter youth's full name)
with a birth date of __________________________(enter youth's birth date) may participate in any and all church-sponsored
activities during the entire year of _______________________(enter current year).
I have read, understood, and will abide by the release as printed below.
Parent's /Legal Guardian's Signature:_________________________________________Date:_________________
Medical Form:
In case of emergency, please contact:
Name ____________________________________________Phone _______________________________
Address ______________________________________________________________________________
Alternate Contact for Emergency:
Name ____________________________________________Phone ______________________________
Relationship to child _________________________________________
Youth?s Physician: ____________________________________ Phone:__________________________
Preferred Hospital: _____________________________________________________________________
Youth?s Dentist: ________________________________________Phone: _________________________
Medical Information: Please list any pertinent health information pertaining to your child.
(i.e. severe allergies, prescription medicines). _________________________________________________
______________________________________________________________________________________
Release Form:
This release is executed between Huff's Union Church and the parent(s)/legal guardian(s) of the youth whose name is listed
above. Such release applies for any and all loss or damage, and any claim or damage resulting from any church sponsored
activity in which your child is involved.
The parent(s) recognizes and affirms that youth activities may be hazardous and include but are not limited to: hayrides,
horseback riding, skiing, tubing, rafting, amusement park rides, and any other activity in which the church youth may
engage. The parent(s)/legal guardian(s) recognizes that their youth participate in such activities at their own risk, that they
voluntarily assume those risks, and that they are fully familiar with all of the inherent dangers.
By signing this form, the parent(s)/legal guardian(s) also releases all youth leaders, pastors, and/or any member of Huff's
Union Church from any liability whatsoever, including but not limited to, on account of first aid treatment or service rendered
to their child during participation in any church activity. In case of emergency, every effort will be made to contact parents.
Signature on this release form hereby grants permission for my child to receive all necessary medical treatment (unless
written otherwise on this form).
The parent(s)/legal guardian(s) further states that he/she has carefully read this release and knows the contents thereof, and
signed this release of their own free act.
Parent's /Legal Guardian's Signature:_________________________________________Date:_________________
Huff's Union Church
Annual Youth Permission / Medical / Release Form
|