PCFS Annual Youth Consent Form

Name of Youth

First NameLast Name

Date of Birth

Date

Current Grade

Youth Cell Phone

If none, please leave blankFormat: 000-000-0000.

Youth Text Updates

I do not give permission for the above named youth to receive informational text messages from the Falling Spring Youth Ministry leaders. I understand that my youth will not be added to the ministry text list and may not receive schedule updates, reminders, or other announcements sent through this method. I understand that I am responsible for obtaining this information through other church communications.

Address

Street Address

Street Address Line 2

CityState

Zip Code

Parent / Guardian 1

First NameLast Name

Relationship to Youth

Best Phone Number

Please enter a valid phone number.Format: 000-000-0000.

Email

example@example.com

Would you like to receive emails from the Falling Spring Youth Ministry? (Approximately 5–10 emails per year.)If you already receive these emails, selecting No will not unsubscribe you.

Parent / Guardian 2 (Optional)

First NameLast Name

Relationship to Youth

Best Phone Number

Please enter a valid phone number.Format: 000-000-0000.

Email

example@example.com

Would you like to receive emails from the Falling Spring Youth Ministry? (Approximately 5–10 emails per year.)If you already receive these emails, selecting No will not unsubscribe you.

Emergency Contact. Please provide someone other than a parent/guardian listed above, if possible.

First NameLast Name

Relationship to Youth

Best Phone Number

Please enter a valid phone number.Format: 000-000-0000.

Helpful Information

Is there anything you would like our youth ministry staff and volunteers to know that would help us care well for your child? (Examples: allergies, medical conditions, dietary needs, learning differences, emotional concerns, family circumstances, fears, or anything else you'd like us to know.)

Participation Consent and Release of Liability

I, the undersigned parent or legal guardian of the youth named on this registration, give permission for my child to participate in the ongoing ministries, programs, activities, and events of the Falling Spring Youth Ministry, a ministry of Presbyterian Church of Falling Spring (PCFS), Chambersburg, Pennsylvania.

I understand that youth ministry activities may include, but are not limited to, Bible studies, worship services, fellowship events, service projects, recreational activities, retreats, local outings, and transportation related to these activities. I acknowledge that participation in these activities involves inherent risks that cannot be completely eliminated.

To the fullest extent permitted by Pennsylvania law, I voluntarily assume the ordinary risks associated with my child's participation and release, waive, and discharge Presbyterian Church of Falling Spring, its staff, and volunteer leaders from liability for any claims, demands, damages, losses, or causes of action arising from injury, illness, property damage, or other loss resulting from my child's participation in youth ministry activities, except to the extent caused by gross negligence, reckless conduct, or intentional misconduct.

In the event of a medical emergency, and if I cannot be reached promptly, I authorize PCFS staff or volunteer leaders to obtain appropriate emergency medical treatment for my child. I understand that I am responsible for any medical expenses incurred.

I affirm that I have provided accurate and complete information regarding my child and will notify the church if there are significant changes to emergency contacts, custody arrangements, medical needs, or other information that may affect my child's participation or care.

Permission is also granted to PCFS to photograph, audio record, or video record my child while participating in youth ministry activities and to use such recordings or images in church publications, websites, social media, bulletin boards, presentations, and other ministry-related promotional materials.

I understand that this consent and authorization remains in effect for the current youth ministry registration year unless revoked in writing or superseded by a new registration. I acknowledge that certain events, such as retreats, mission trips, or other special activities, may require additional event-specific consent forms.

By signing below, I certify that I am the parent or legal guardian of the above-named youth, that I have read and understand this Participation Consent, Release of Liability, and Media Authorization, and that I voluntarily agree to its terms.

Parent/Guardian Name

Parent/Guardian Signature