Youth Group Permission Form
This form is to be used for any youth group activities that happen away from the premises of Christ United Methodist Church. Youth will not be permitted to participate in any such activities without having an event specific form filled out by a parent or guardian, in addition to the current Youth Registration Form.
Youth Event *
Date of Event *
MM
/
DD
/
YYYY
First Name of Youth *
Last Name of Youth *
Name of Parent/Guardian (Last, First) *
Parent/Guardian Home Phone *
Parent/Guardian Cell Phone *
Parent/Guardian Additional Phone
Emergency Contact #1 Name & Relation to Youth *
Emergency Contact #1 Phone *
Emergency Contact #2 Name & Relation to Youth *
Emergency Contact #2 Phone *
Please Read Carefully
I give my permission for my child (named above) to participate in the CUMC event listed above. The medical waiver included in this document shall be in effect from the time my child is dropped off until he/she is released back to me or my agent.

I understand that transportation during this Christ UMC sponsored Youth event will be provided by Youth Leaders and/or chaperones 25 years of age or older. Transportation may be by private vehicle or rental vehicle.

I acknowledge that while the church will make every attempt to meet the recommendations for safety, they cannot guarantee that background clearance will be available for all individuals present at this function. They will attempt to have at least one male and one female chaperone, with appropriate clearance, in attendance at all times.

In the event of a medical or dental emergency, I authorize any Youth Leader or adult chaperone of Christ United Methodist Church, as an agent for me, to consent to any examination or treatment which is deemed advisable by, and is rendered by or under the supervision of, any physician or surgeon licensed under provisions of the Medical Practice Act including, but not limited to, hospitalization, surgery, medication, radiological procedures, transfusions, and anesthesia. Such examination, diagnosis and/or treatment may occur at any licensed hospital, emergency room, clinic, physician’s office, surgeon’s office, or dental facility. I understand that all reasonable attempts will be made to contact me prior to the initiation of any examination, diagnosis and/or treatment.

I release Christ United Methodist Church, its staff, volunteers, and chaperones from liability for any illness or injury en route to, during, or returning from this event and from any responsibility and/or liability resulting from any act authorized by this document.
Permission Signature
By typing your name below, and submitting this form, you indicate that you agree to the terms outlined above.
Parent/Guardian Name and Date *
Submit
Never submit passwords through Google Forms.
This form was created inside of Christ United Methodist Church. Report Abuse