TRINITY YOUTH MINISTRIES

STUDENT LIABILITY RELEASE FORM

7th - 12th Grades

STUDENT INFO

PARENT/GUARDIAN INFO

EMERGENCY CONTACT INFO

MEDICAL/HEALTH INSURANCE INFO

PLEASE READ the following and SIGN:

Publicity/Information Release

I hereby give Trinity United Methodist Church the absolute right and permission to use, publish and republish photographs and/or video of my child taken during the dates contained by this release, in whole or in part.  I assign all rights to the photographs to Trinity United Methodist Church and authorize the reproduction, sale, publication, transmission, broadcast, and/or distribution of said photographs without limitation.  This may include, but not be limited to brochures, newsletters, videos and/or websites.  These images will be used for a variety of church related purposes, and I understand these images may be used without further notifying me.  I also give permission to publish address/phone information in the local youth directory.  Demographic information only will be provided to the church office and United Methodist conference office if requested but will not be shared with any other source.

Release of All Claims

In consideration for being accepted by Trinity United Methodist Church for participation in all TUMC youth activities, I do hereby release, forever discharge and agree to hold harmless said church and the directors thereof from any and all liability, claims or demands for personal injury, sickness or death, as well as property damage and expenses, if any may be incurred by the undersigned participant while participating in the above-described activity.

Furthermore, I hereby assume all risk of personal injury, sickness or death, damage and expense as the result of participation in recreation and work activities involved therein.

Further, authorization and permission is hereby given to said church to furnish any necessary transportation, food and lodging for this participant during scheduled trips and/or activities.

The undersigned further hereby agree to hold harmless and indemnify said church, its directors, employees and agents, for any liability sustained by said church as the result of the negligent, willful or intentional acts of said participant, including expenses incurred attendant thereto.

As participant, I hereby grant permission to transport me to a doctor or hospital and authorize medical treatment, including but not limited to emergency surgery or medical treatment, and assume responsibility of any and all medical bills.

Further, should it be necessary for me as participant to return home due to medical reasons or otherwise, I hereby assume all transportation costs.

Student Covenant of Conduct

I am a representative of the Christian community, and I am responsible for my actions.  I understand and agree to the following guidelines at all youth events both on and off site.

1.  I will respect the health of my own body by refraining from the use of tobacco, alcohol and drugs of any kind, except those prescribed for me by a physician.

2.  I will not bring any weapons or other substance that might harm myself or others.

3.  I will be responsible for my own behavior and participate fully in all scheduled activities and events, which I choose to attend.

4.  I will dress in good taste.  No alcohol, tobacco, narcotics, or suggestive slogans, symbols, or sayings.

5.  I will keep the areas of the church (or whatever facility we are at) clean and stay out of areas not approved for our use.

6.  I will respect each person’s physical space and property and it shall remain off limits to me.

7.  I will respect the physical and emotional well-being of other youth and adults by “doing unto them, as I would have them do unto me.”

8.  I will comply with the instructions of the adults/sponsors in charge at all times.

Student and Parent/Guardian Acknowledgement

I have read the above and agree to all the stipulations contained herein. I understand that not complying with these rules will result in the immediate notification of my parents and I will be sent home (at my parents’ expense if applicable) or my parents will pick me up immediately.

If Student is under 18, guardian must sign the following…

Parents’/Guardians’ Consent:  I am the parent or the guardian of the above-named minor and hereby approve of this release and give my consent.  I will notify the Youth Director as any of the information on this form changes.