St. Philip's Lutheran Church - Children & Youth Permission Form 2021-22
This form covers all St. Philip’s Lutheran Church Children & Youth activities and events for the 2021-2022 Program Year.
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Child's Name *
I/we give consent for our child to attend and participate in any youth events, activities and programs being organized or sponsored by St. Philip’s Lutheran Church. This permission extends to travel to/from any event, activity or program. Activities may include, but are not limited to: small groups, large groups, overnights, bowling, cookouts, swimming, water parks, games in the park, concerts, sledding, ice-skating, downhill skiing, snowboarding, miniature golfing, Valleyfair, etc. *
I/we understand the nature of these events and do hereby release St. Philip’s Lutheran Church from any liability due to accident or injury incurred by my/our child. *
In the event that my child is ill, injured, or otherwise requires medical examination, treatment, or care while under the supervision of St. Philip’s Lutheran Church or its staff or volunteers, I/we consent to, and will be responsible for, payment of charges for any such treatment or examination. *
I/we further agree to release St. Philip’s Lutheran Church, and its staff or volunteers acting on its behalf, free and harmless of any claims, demands, or suits arising from their conduct to the full extent permitted by Minnesota law in conjunction with any event or related travel, including the authorization and provision of medical treatment. *
I/we agree to cover all costs if my/our child needs to be sent home for disciplinary reasons or any damages need to be financially covered. *
Parent/Guardian Signature **Parent/Guardian please type your name below** *
Today's Date *
Phone number where parent can be easily reached *
Additional Emergency Contact (name and phone number) *
Special medication or allergies. **please list, or type none** *
St. Philip’s Lutheran Church has my permission to include my child in any photographs or videotapes taken during St. Philip’s youth group or Confirmation events. I further understand that these photos and/or videos may be shared with youth, parents, the St. Philip’s web page, app, Instagram, Facebook, and future printed or electronic publications. *
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