Faith Baptist Church
Universal Permission Form

Youth Information

First Name

Last Name

Birthdate

Gender

Grade

Email

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Phone Number

Parent/Guardian Information

First Name

Last Name

Phone Number

Email

First Name

Last Name

Phone Number

Email

Emergency Contact

First Name

Last Name

Phone Number

Relationship to Youth

Parental Consent

The undersigned does hereby give permission for my child "Participant" , to attend, and participate in any Faith Baptist Church children/youth ministry activities, events, retreats and childcare during the period indicated.

LIABILITY RELEASE: In consideration of Faith Baptist Church allowing the Participant to participate in all children/youth ministry activities both on site and away for the church premise and childcare, I the undersigned, do hereby release, forever discharge and agree to hold harmless and indemnify Faith Baptist Church, its pastors, directors, employees, volunteers and teachers (collectively herein the "Church") from any and all liability, claims, or demands for accidental personal injury, sickness, or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by the undersigned and the Participant while involved in the children/youth activities and childcare. I the parent or legal guardian of this Participant hereby grant my permission for the Participant to participate fully in children/youth ministry activities and child care, including trips away from the church premises. Furthermore, I, on behalf of my minor Participant, hereby assume all risk of accidental personal injury, sickness, death, damage, and expense as a result of participation.

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Youth First Name

Youth Last Name

Youth Participant Signature

Date Input

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Signature

Date Input

Medical Information/Primary Care Physician

First Name

Last Name

Phone Number

Name of Practice

Insurance Information

Medical Insurence Company

Phone Number

Policy Group ID

Policy Holder's Name

***Please send a copy of Medical Insurance to the church. ***

Medication

List all medications the youth will be take during youth ministry trips, retreats, or events. This includes any prescriptions, non-prescriptions medications, herbal supplements and vitamins. Any participant under the age of 18 is required to give ALL MEDICATIONS to the adult youth leader in their original containers with complete dispensing instructions before the start of the event. Youth are not permitted to carry any prescription or non-prescription medication and will be sent home ta the parent/guardian expense if they do.

Medications

Over-The-Counter Medication

Do you give permission for your child/youth to be given over-the-counter medication as needed and as directed on the label, to treat non-emergency medical conditions that do not require a doctor or hospital visit such as a minor headache, stomachache, or allergic reaction while at a ministry event?

Yes

No

Medical Conditions:

Please answer the following medical condition questions.

***If you chose other please lists here

Faith Baptist Church
Convenant of Community Expectations

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Youth Participant

By signing this form, I pledge to honor God and respect others during activities, events, and meetings by following the rules and guidelines stated above. I understand that I cannot participate in the ministry unless this form is on file.

Youth Participants Signature

Date Input

Parent/Guardian

By signing this form, I agree to support the Covenant of Community Expectations stated above, and will accept responsibility for the payments of my child/youth's return transportation should they break one of the non-negotiable rules.

Parent/Guardian Signature

Date Input

Faith Baptist ChurchUniversal Permission Form

Youth Information

Parent/Guardian Information

Emergency Contact

Parental Consent

Medical Information/Primary Care Physician

Insurance Information

Medication

Over-The-Counter Medication

Medical Conditions:

Faith Baptist Church Convenant of Community Expectations

Youth Participant

Parent/Guardian

Faith Baptist Church
Universal Permission Form

Faith Baptist Church
Convenant of Community Expectations