2022-2023 PARENTAL CONSENT AND LIABILITY RELEASE FORM
2022-2023 Parental Consent and Liability Release Form
(Please complete and sign form in its entirety)
LIABILITY RELEASE: In consideration of Korean United Methodist Church of Greater Washington allowing the Participant to participate in Children or Youth Ministry activities, I, the undersigned, do hereby release, forever discharge and agree to hold harmless Korean United Methodist Church of Greater Washington, the United Methodist Church (Virginia Annual Conference & Arlington District), it’s pastors, directors, employees, volunteers and agents (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 or youth activity. I, the parent or legal guardian of this participant hereby grant my permission for the participant to participate fully in children or youth ministry activities, including trips away from the church premises. Furthermore, I [and on behalf of my minor participant] hereby assume all risk of accidental personal injury, sickness, death, damage and expense as a result of participation in recreation and work activities involved therein. Furthermore, authorization and permission is hereby given to said Church to furnish any necessary transportation (within the limitations of church insurance and the law), food and lodging for the Participant. The undersigned further hereby agree to hold harmless and indemnify said Church for any liability sustained by said Church as the result of the negligent, willful or intentional acts of said Participant, including expenses incurred attendant thereto.
MEDICAL TREATMENT PERMISSION: I, authorize an adult, in whose care the minor has been entrusted, to consent to any emergency x-ray examination, anesthetic, medical, surgical, or dental diagnosis or treatment and hospital care, to be rendered to the minor under the general or special supervision and on the advice of any physician or dentist licensed under the provisions of the medical Practitioners Act on the medical staff of a licensed hospital or emergency care facility. The undersigned shall be liable and agree to pay all costs and expenses incurred in connection with such medical and dental services rendered to the aforementioned child or youth pursuant to this authorization.
EARLY RETURN HOME POLICY: Should it be necessary for my child or youth to return home due to medical reasons, disciplinary action or otherwise, the undersigned shall assume all transportation costs and responsibility.
TRANSPORTATION PERMISSION: The undersigned does also hereby give permission to the participant to ride in any vehicle driven by an approved ADULT chaperone while attending and participating in activities sponsored by Korean United Methodist Church of Greater Washington. The participant and I understand that seat belts shall be worn at all times during transportation.
PHOTOGRAPHY & VIDEO CONSENT: The undersigned gives permission for Korean United Methodist Church of Greater Washington to photograph or video recording my child/youth during children and youth activities. I understand that these photos and videos could be used on the Korean United Methodist Church of Greater Washington and Kingdom Kids websites, newsletter, be posted on social media such as Facebook as well as be posted on bulletin boards, and displayed on the projection screen in the sanctuary.