2019-2020 Permission & Release Form
I/we do hereby, for myself/ourselves, my/our heirs, successors, and assigns, release and hold harmless St. Giles Presbyterian Church (“St. Giles”), its successors and assigns, and any of its officers, members, representatives, or agents from any and all liability and/or actions or causes of action which might arise from any accident which might occur or injuries that take place when my child named above participates in youth ministry activities sponsored by St. Giles between **September 2019 and September 2020** or until a written withdrawal of such authorization is on file in the church office. Additionally, I grant authorization for my child to leave the church premises under the supervision of church staff and/or approved volunteers, and give permission for my/our child to ride in any vehicle driven by an approved volunteer while attending and participating in activities sponsored by St. Giles. Should it be necessary for my/our child to return home from a St. Giles sponsored trip due to medical reasons, disciplinary action, or otherwise, I/we understand that I/we shall assume all transportation costs and responsibility.

I/we further authorize St. Giles or any of its officers, members, representatives, or agents to seek emergency medical care and/or treatment for my/our child and to admit my/our child to any hospital or other medical facility, having made a reasonable effort to contact me/us prior to seeking treatment. If medical care and/or treatment is deemed necessary by a duly licensed healthcare provider, doctor, hospital, or clinic, I/we authorize St. Giles, its officers, members, representatives, or agents to consent to any such medical care and/or treatment.

Youth's First Name *
Please type the first name of the youth participant. (Youth Advisors/Adult Chaperones filling out a form for themselves should put their own name on this line)
Your answer
Youth's Last Name *
Please type the last name of the youth participant. (Youth Advisors/Adult Chaperones filling out a form for themselves should put their own name on this line)
Your answer
Date of Birth *
MM
/
DD
/
YYYY
2019-2020 Grade Level *
Youth Email Address *
Please include your child's email address. If your child does not have an email address, please write "N/A"
Your answer
Youth Cell Phone *
Please include your child's cell phone number. If your child does not have a cell phone, please write "N/A"
Your answer
Photo Release *
Please indicate below to GRANT or DENY permission for St. Giles to use your child's photos in print (e.g.,. bulletin, brochure) and electronic (e.g., website, social media) formats. Please note that when photos are used digitally, St. Giles will not include names of children under age 18.
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