CrossTraining Medical/Release Form

Medical & Photo Release Form

Each student must fill out the information below completely. This form will be kept on file for one (1) year as a medical release. If your medical or insurance information changes, please contact Chad Kennington or submit another online form to update your information. Form is valid for the year of 2023 and indicates that the listed participant will be participating in Student Ministry activities in the Student Ministry at Tuscumbia First Methodist Church.
Student's Name*

First NameLast Name
Gender*

FemaleMale
Date of Birth*

MonthDayYear
Date
Age*
School*
Grade*
Student Cell Phone
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Special medical needs or concerns (allergies, conditions, dietary needs, medications, etc.)
Medical Doctor
Doctor Phone
Please enter a valid phone number.
Insurance Company*
Policy Number*
Swimming Ability

non-swimmermoderateadvanced
Parent / Guardian Name*

First NameLast Name
Cell Phone Number*
Other Phone Number
Parent's Email
example@example.com
Emergency Contact (If parents cannot be contacted)*

First NameLast Name
Emergency Contact Phone Number*
Functions and Activities

It is my understanding that participating in the programs and recreational and other activities of Tuscumbia First Methodist Church is a privilege. Prior to my participation in such activities, I acknowledge that there are certain risks associated with the activities, including, by way of example, physical injury due to activity-related accidents, physical injury due to transportation-related accidents, illness, or even death. In addition, I acknowledge that there may be other risks inherent in these activities of which I may not be presently aware.
Release of Liability

By signing this Permission/Waiver Form, I expressly warrant that the child named above is capable of withstanding both the physical and mental demands of the activities discussed above. I also expressly assume all risks of the child participating in the activities, whether such risks are known or unknown to me at this time. I further release Tuscumbia First and its ministers, leaders, employees, volunteers, and agents from any claim that my child may have or that I may have against them as a result of injury or illness incurred during the course of participation in the activities. This release of liability shall include (without limitation) any claims of negligence or breach of warranty. This release of liability is also intended to cover all claims that members of the child's or my family or estate, heirs, representatives, or assigns may have against Tuscumbia First or its ministers, leaders, employees, volunteers, or agents. I further agree to indemnify and hold harmless Tuscumbia First and its ministers, leaders, employees, volunteers, or agents from any and all claims arising from my participation in its activities and programs, or as a result of injury or illness of my child during such activities.
First Aid and Emergency Medical Treatment

I recognize that there may be occasions where the 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 Tuscumbia First to seek and secure any needed medical attention or treatment for the 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 to obtain medical treatment. I give permission for attending physician(s) and other medical personnel to administer any needed medical treatment, including surgery and, again, I agree to pay for the medical treatment.
Parent signature

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Photo Consent

I hereby grant Tuscumbia First permission to use my student’s likeness in photograph/video in any and all of its publications, including website entries, without payment or any other consideration. I
understand and agree that these materials will become the property of Tuscumbia First and will not be returned. I hereby irrevocably authorize Tuscumbia First to edit, alter, copy, exhibit, publish or distribute this photo for purposes of publicizing Tuscumbia First programs or for any other lawful purpose. By signing you are giving consent. If you wish to withhold photo consent do not sign below.
Signature for Photo Consent

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Submitted Date*

MonthDayYear
Date
CrossTraining Youth Ministry Covenant

In signing this covenant, I agree to live by the following guidelines listed below during any youth activity or event in order to glorify Christ in all that I do and represent Him to others.
- Be responsible for my own behavior and participate fully in all scheduled activities of any event, including staying with the group at all times, and abide by group decisions made during the event.
- Respect and obey the authority of all adults present at a youth activity or event.
- Respect the physical and emotional well-being of other youth and adults, including respecting the need for sleep and refraining from harmful practical jokes.
- Respect the privacy of other youth and adults by not entering the rooms of the opposite sex and acting appropriately, including no public displays of affection (PDA).
- Respect the property and rules of any place where a youth activity or event takes place.
- Respect the health and well-being of my own body by not possessing or using drugs, tobacco, or alcohol; bringing fireworks, knives, or weapons of any kind; and by dressing modestly (one-piece or modest tankini swimsuits for girls, no short-shorts or mini-skirts, and no bare stomachs).
- All prescription medicine must be disclosed and must be given to a designated counselor who will distribute it and supervise the youth taking the medicine.
- Behave appropriately with electronic devices by not viewing or listening to inappropriate media; not using your device during worship, teaching, or any other inappropriate time.
- Please do not bring anything extremely valuable or expensive. You are responsible for any lost, stolen, or broken items.
I understand that the purpose of this covenant is to allow for the well-being and safety of myself and others. I agree to the following consequences of not following these guidelines and understand that it is the supervising adult’s discretion as to how serious my offense is:

In the event of repeated offenses, criminal behavior, or dangerous behavior a phone call to your parents and/or a request to come and take you home may be merited.

I hereby agree to adhere to the above covenant.
Student Signature*

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Parent Signature

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Submitted Date*

MonthDayYear
Date
Should be Empty:

Medical & Photo Release Form

Functions and Activities

Release of Liability

First Aid and Emergency Medical Treatment

Photo Consent

CrossTraining Youth Ministry Covenant