CENTRAL CONGREGATIONAL CHURCH PARENTAL CONSENT AND RELEASE FORM
__________________________ parent(s) / guardian(s) of youth group participant
___________________________ celebrate the fact that our child is involved in this youth group in some way. We recognize the importance of the commitment that he/she makes and that their participation in this trip as a part of a larger community calls for responsible behavior. Therefore, I/we agree that if this child engages in behavior which, in the judgment of the adult leaders, is not in the best interest of the trip, my child or any member of the group should, therefore, be sent home. I/We will assume full legal and financial responsibilities for such a return trip. I/We also do hereby release from any liability Central Congregational Church United Church of Christ, the United Church of Christ and any and all adult leaders and church staff from any claims for an unintended or unexpected accidents which might occur during this trip or traveling to or from our destination. I also authorize S. Kathryn Townes and the other adult leaders to approve or authorize any emergency medical treatment for this child in the event such treatment becomes necessary before I/we can be contacted.
Parent/Guardian Signature: ____________________________ Date:_________
Parent/Guardian Phone Numbers:
Youth Group Event and Dates: Homeless Awareness Sleepout, Jan. 22-23
Emergency Contact Name/Number:
Medical Insurance and Policy/Group #:
Medications child is taking, allergies, or medical conditions (use back if needed):
Please note that Central Congregational Church UCC sometimes takes photographs and records video at youth events for use in church materials in print and online. If you have concerns about your child appearing in these materials, please contact Kat Townes at kat@centralchurch.us and we will do our best to address them. Central will not share your private information with outside organizations.
