Youth Permission Forms 2023-2024

Consent for Treatment and Release Form

Step 1 of 3

Minor Release Form
I (Parent or Guardian),*
First Last
Minor's Name*
First Last
Permission & Acknowledgment
I give permission to the above mentioned minor to attend Youth Activities from September 1, 2023 – September 1, 2024 under the guidance of the Wye Bible Youth Ministry Team. This includes participation in all of its activities, including being conveyed in a vehicle to and from any destinations.

I acknowledge that participation in the above trips involves risk to the Participant (and to the Participant’s parents or guardians, if Participant is a minor), and may result in various types of injury including, but not limited to the following: sickness, bodily injury, death, emotional injury, personal injury, property damage and financial damage. In consideration for the opportunity to participate in the above trips, the Participant (or parent/guardian if Participant is a minor) acknowledges and accepts the risks of injury associated with participation in the trip. The Participant (or parent/guardian) accepts personal financial responsibility for any injury sustained during the trip. Further, the Participant (or parent/guardian) promises to indemnify, defend, and hold harmless the Trip Sponsor and its agents, employees, volunteers, or any other representatives (collectively included hereinafter in the term “Trip Sponsor”) for any injury related directly or indirectly out of the above trip, whether such injury arises out of the negligence of the Trip Sponsor or otherwise.
I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature.*
- By checking this box and typing my name below, I am electronically signing my application.
Signature of Parent or Legal Guardian*
First Middle Initial Last
Address*
Street Address City State / Province / Region ZIP / Postal Code
Minor's Birthdate*
Home Phone
Cell Phone*
Parent Email*
Youth Email
Emergency Contact other than Parent or Legal Guardian:*
First Last
Emergency Contact Phone*
Pertinent Medical Information:

Consent For Medical and/or Emergency Treatment
I,*
First Last
hereby voluntarily consent to the rendering of such care, including diagnostic procedures, surgical and medical treatment and blood transfusions, by medical doctors, hospitals or their authorized designees, as may in their professional judgement be necessary to provide for the medical, surgical or emergency care of my
(relationship to minor)*

(relationship to minor)
(hereafter "dependent")*
First Last
(hereafter “dependent”)
Date*
I further give my consent for the Wye Bible Church youth team, who will be caring for my dependent during Youth activities/trips from September 1, 2023 – September 1, 2024 to arrange for routine or emergency medical and/or dental care and treatment necessary to preserve the health of my dependent. In the event that my dependent is injured or ill while under the care of the caregiver, I hereby give permission to the caregiver to provide first aid for said dependent and to take the appropriate measures, including contacting the Emergency Medical Service (EMS) system and arranging for transportation to the nearest emergency medical facility.

In making medical decisions on my behalf for the benefit of my dependent, I direct that the caregiver attempt to contact me. However, if medical care becomes essential, I give permission to the caregiver to make such decisions regarding such treatment as deemed appropriate by the medical doctor, hospital or their authorized designee. In furtherance of any treatment decisions to be made by the caregiver on my behalf of my dependent, I authorize the caregiver to request, obtain, review and inspect any and all information bearing upon my dependent’s health and relevant to any such decisions to be made respecting such treatment.

I acknowledge that no guarantees have been made to me as to the effect of such examinations or treatment on the condition of my dependent and that I am responsible for all reasonable charges in connection with the care and treatment rendered to my dependent during this period.
I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature.*
- By checking this box and typing my name below, I am electronically signing my application.
Signature of Parent or Legal Guardian*
First Middle Initial Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Health Insurance Carrier*
Health Insurance Policy # and Group #*
Personal Care Physician*
Phone*
Allergies*
Medications dependent is taking

Parental/Guardian Travel Consent
Minor*
First Last
is participating in the Wye Bible Church Youth group. I recognize that members of the Youth Team may have occasion to travel with my child. Such travel may be required for my child to participate in activities that may or may not be sponsored by Wye Bible Church. I understand that no one may take my child on a trip outside of the State of Maryland overnight for a period of over twenty-four hours without my prior consent. I further understand youth leaders of Wye Bible Church will have knowledge of my child’s whereabouts at all times.
Publication/Website Permission Form
I grant Wye Bible Church permission to record the image/voice of my child(ren) listed below and use the recording for non-commercial purposes. This recording may be in the form of a photograph, film audio or video tape, digital or other electronic format and may be used on the Wye Bible Church’s website or in publications. Published documents shall NOT include a child’s full name, home address, phone number or the full names of other family members. Photo captions shall not identify students by full name.
*
Revocation
I understand that I have the right to revoke this authorization, in writing, at any time by sending written notification to Wye Bible Church at 115 Narnia Dr, Grasonville, MD 21638. I further understand that a revocation of this authorization is not effective to the extent that the action has been taken in reliance on the authorization.
Expiration
Unless sooner revoked, this consent expires one (1) year from the date signed.
I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature.*
- By checking this box and typing my name below, I am electronically signing my application.
Signature of Parent or Legal Guardian*
First Middle Initial Last
Date*
MM slash DD slash YYYY

Youth Permission Forms 2023-2024

Step 1 of 3

Minor Release Form

Permission & Acknowledgment

Consent For Medical and/or Emergency Treatment

Parental/Guardian Travel Consent

Publication/Website Permission Form

Revocation

Expiration