Annual Youth Permission Form

Annual Permission, Authorization, and Release

am the parent and/or lawful guardian of:

who are minors.

I understand that the GEMS, Cadets, Junior High Youth Group, High School Youth Group are organizations of Sunnyside Christian Reformed Church.  

 

As Parent, I hereby give my Permission for my Child(ren) to participate in the events and all related activities during 2018-2019 (see list below). I also, hereby give Authority to the adult leaders of the Organization and any other employees, servants and agents of Sunnyside Christian Reformed Church (“SCRC Agents”) to consent, in my place and with the same authority as I have, to any medical treatment that may be required by Child in connection with the event.

Sunnyside CRC youth groups offer several off-campus events throughout the year.  Do you give your child(ren) permission to attend off-campus events?

Do you require that your child(ren) has a separate permission slip for each event?  There will likely be off campus events added to this list throughout the year.

In consideration of the services performed by SCRC Agents, I hereby Release Sunnyside Christian Reformed Church and all SCRC Agents from any and all liability for any damage, injury or loss arising out of actions taken in good faith in connection with the Event, regardless of whether caused by the negligence of any party hereby released.

List any medications, allergies, past medical history, or any activity or dietary restrictions we need to know about.

Are you aware of any RECENT injuries, illnesses, or other medical conditions that may cause additional and/or new injury when participating in any event?

CONSENT FOR EMERGENCY TREATMENT  In case of emergency, I hereby give permission to the physician selected by Sunnyside Christian Reformed Church leaders to hospitalize, secure proper treatment for and order injection, anesthesia, or surgery, for my child/ward as named above.  In the event medical treatment is necessary, as stated, I give permission for my child to participate in all activities. If any changes occur, I will contact Sunnyside Christian Reformed Church at the above address.     I, therefore, agree to assume as an explicit condition of my child’s/ward’s participation, any and all risks.  I agree to hold harmless Sunnyside Christian Reformed Church, its personnel, or other individual transporting my child from any and all liability, claims, damages, and expenses that may arise due to participation of my child/ward in any activities of the above organization.     I understand it is my responsibility to inform Sunnyside Christian Reformed Church leaders of my child’s/ward’s change in any medical history that may cause additional and/or new injury when participating in any and all events.

Sunnyside Christian Reformed Church

700 North 16th Street | Sunnyside, WA| 98944
509-837-5371 | scrcoffice3@gmail.com | Map