Youth Group Registration & Permission Slip 2024

Parent Information

Parent/Guardian's Name:

Parent/Guardian's Phone

Parent's Email

This address will receive a confirmation email

Address

Child Information:

Student's Name

Student's Phone

Student's Email

Does the student have any alergies?

Is there anything else we should be aware of that may impact the student's ability to participate?

Consent & Certification:

I, the undersigned, being the parent or legal guardian of the youth named above, do hereby consent to the participation of my youth in all the scheduled youth activities of Windham Presbyterian Church, and any other supervised activities associated with its youth group, including youth group meetings and overnight or weekend youth trips. Further, I certify that my youth is physically fit and adequately prepared to participate in all recreational and sporting events. If I wish to revoke this consent for any reason, I will promptly notify the NextGen Director in writing.

Medical Treatment Authorization

I understand that I will be notified in the case of a medical emergency. However, in the event that I cannot be reached, I authorize the calling of a doctor and the providing of necessary medical services in the event that my youth is injured or becomes ill. I authorize one or more of the following persons to make emergency medical care decisions on behalf of my youth, if required by law or a health care provider: WPC's pastor, NextGen Director, volunteer youth leaders, or another adult designated by the pastor or NextGen Director. I authorize these persons to act in my place to consent to all necessary and appropriate x-ray examinations, anesthetic, medical or surgical diagnosis or treatment, and hospital care. I understand that the staff and volunteers of WPC will not be responsible for medical expenses incurred solely on the basis of this authorization. I further agree to notify the NextGen Director in writing of any health changes that would restrict my youth’s participation in any normal youth activities. I also understand that the NextGen Director and volunteer youth leaders reserve the right to restrict my youth from any activity that they do not feel is within the physical capabilities of my youth.

Photo and Communication Permissions

I understand that photo/video may be taken on WPC's Youth Group events and accept that that this media may be posted to WPC's website or social media platforms.

Yes No

I give my permission for the NextGen Director and volunteer leaders to contact my child(ren) directly (via email or text) to communicate about Youth Group events.

Yes No

Emergency Contact

If we are unable to reach you, please provide another phone number for us to try.

Description

Please register to participate in our weekly YG gatherings and other YG events!

Youth Group Registration & Permission Slip 2024

Description

Please Fix the Following