Mount Bethel Youth Group Health and Permission Form 2019

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Child's Information

 
 
 
 
 
 
Parents/Guardians

 
 
 
 
 
Medical Release

I, the undersigned, give my child permission to participate in activities and events sponsored by Mount Bethel Church. Such activities include, but are not limited to: skiing, sledding/tubing, dodgeball, basketball, football, soccer and other sports, games which may involve running, physical contact and nighttime conditions, swimming, canoeing, tubing and other activities involving water, activities involving food, camping and/or bonfires, waterslides, “slip and slides”, amusement park rides and related activities and manual labor.
I also give my child permission to be transported to and from any events by adults in privately owned vehicles or bus(es).

In the event of a medical emergency, I give permission for my son/daughter to receive medical treatment for injury or illness, in accordance with standard medical practice by licensed medical personnel when it is not practical to obtain the consent of the undersigned. Permission is also granted to treat minor injury on a first aid basis. Further, I agree to accept any and all financial responsibility as a result of scheduling such treatment.

I will not hold the sponsoring agency or its representatives liable in that my son/daughter sustains injury not resulting from the negligence of said sponsoring agency, its representatives, agents, and employees. My son/daughter agrees to respect and abide by all of the guidelines for the event. I understand that the church will not be held liable if my son/daughter fails to cooperate with said guidelines and that any infractions of these may result in immediate dismissal from the event.
Please select all that apply.
 
Medical Information

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Please select all that apply.
 

Description

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