2022 Youth Group Participant Form

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Participant Information

 
 
 
 
 
 
 
 
Parent/Guardian Information

 
 
 
Please select all that apply.
 
Please select all that apply.
Medical Information

 
 
 
 
Health Insurance

 
 
 
 
Emergency Contact

 
 
 
 
Permission to Participate

I understand that youth activities, events and trips sponsored by ROSEWOOD REFORMED CHURCH may require sound physical and mental health.  By signing this form, I expressly warrant my child named above is capable of withstanding both the physical and mental demands of such activities, and that I have been informed regarding the nature of these activities and demands.  I further understand that I may request that my child named above be excluded from participation in any sponsored activities, events or trips should such activities, events or trips be noted below (please list activities, events or trips that your child MAY NOT participate in)

 
First Aid and Emergency Medical Treatment

I recognize that there may be occasions where my child named above may be in need of first aid or emergency medical treatment as a result of an accident, illness, or other health condition or injury. I do hereby give permission for agents of Rosewood Reformed Church to seek and secure any needed medical attention or treatment for my child named above, including hospitalization, if in the agent's opinion such need arises. In doing so, I agree to pay all fees and costs arising from this action.  I further give permission for attending physician(s) and other medical personnel to administer any needed medical treatment, including surgery, if deemed necessary.

Photo/Videography Use Consent

I grant permission for photos/video of my student to be posted on the personal and/or church social media sites of the Rosewood Youth Ministry Program Director and any Rosewood Youth Ministry Team Leader as a way of sharing and celebrating our youth ministry.  Photos/video may also be used in promotional materials and/or church website.                                        
Please select one option.
Authorization from Parent/Guardian

I represent that I am the parent/guardian of the YOUTH NAME ABOVE, who is under 18 years of age. I have read the above information and am fully familiar with the contents thereof.  I give permission for my child named above to participate in all sponsored youth activities, events and trips, unless noted. 

By typing your name, you are agreeing to the terms in the agreement above.

 
 
 
 
 
 

Description

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