Release Form for Guests of St. Michael's Youth Ministry Events

Emergency Contact (other than above parent/guardian)

Permission to receive OTC medications:

I give my permission for my child to receive over the counter medications from adult leadership at events, such as Tylenol, ibuprofen, cough drops, Mylanta, etc., unless listed above.

Parent/Guardian Authorization for Health Care:

I give permission, to the provider, selected by the church, to order x-rays, routine tests, and treatment related to the health of my child in emergency/urgent situations. If I cannot be reached in an emergency, I give my permission to the physician to hospitalize, secure proper treatment for, and order injection, anesthesia, or surgery for this child. I understand the information on this form will be shared on a “need to know” basis with youth leadership.

Photo/Video Publicity Release Statement:

I give my permission for photographs or video footage of my child to be used by St. Michael’s Episcopal Church for promotional purposes (Brochures, website photos, promotional videos, social media, etc.) No names are used for promotional photos/videos

Teen Consent:

In order to maintain a physically, emotionally, and spiritually safe space for all participants of this event, I agree to actively participate in all parts of the event (as able) and abide by the following community standards:

1. I will respect and follow the rules for the event.
2. I will respect the physical property of the facility, and the property of each person at the event.
3. I will remain on the premises and be an active participant in all scheduled activities for the event.
4. I will wear appropriate clothing.
5. I will not enter any designated sleeping areas other than my own.
6. I will not engage in sexual behavior, including sexual misconduct, sexually explicitly communication, or harassment.
7. I will not use or be in possession of alcohol, illegal drugs, or tobacco.
8. I will not bring anything that could be considered a weapon, such as firearms, knives, pocket knives, or fireworks.
9. I will not participate in acts of violence, aggression, or fighting.

By signing below, I agree that these are reasonable expectations and I will do everything I can to live up to them. If I choose to violate the rules set for the event I am attending, I understand that there will be consequences, which may include my being sent home at my own expense and without refund.