Note: Newsletters will be emailed to parent's email address.
In signing this, I am also giving permission for (child's name) the youth and adult chaperones of Shepherd of the Hills to all youth activities from September 2022 through August 2023.
This form will be presented to the attending physician if your child is in need of emergency medical treatment during one of our events. I, the undersigned parent/legal guardian of through reasonable efforts, do hereby empower and grant to Shepherd of the Hills Lutheran Church and its agents, permission to consent to any medical or surgical diagnosis or treatment or hospital care for my above-named child.
I, the undersigned parent/legal guardian also understand that participation includes possible exposure to and illness from infectious diseases including but not limited to influenza and COVID-19. While particular rules and procedures may reduce the risk, the risk of serious illness does exist. Therefore, I knowingly and freely assume all such risks and assume full responsibility for my participant.
This authorization applied to all youth activities sponsored by Shepherd of the Hills Lutheran Church for the period of time from September 2022 through August 2023. This consent may be revoked at any time by giving written notice to a Pastor.