(ADD ON 2) Youth Volunteer (Parent/Guardian Authorization for Designated Adult)

PARENT/GUARDIAN AUTHORIZATION FOR DESIGNATED ADULT SUPERVISION

Please note, a "Volunteer Waiver for Youth participating with a Parent/Guardian" is required WITH this form.
I understand that [FIRST PRESBYTERIAN CHURCH OF HAYWARD / FIRSTPRES] requires minors participating in volunteer activities to remain under the supervision of a parent, legal guardian, or another responsible adult who has been specifically designated by the parent or legal guardian.

I authorize the adult identified below to supervise my minor child during the volunteer activity identified in this waiver.
MINOR PARTICIPANT(S)
Minor/YouthFull Name:

First NameLast Name
Date of Birth:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
(2) Minor/YouthFull Name:

First NameLast Name
(2) Date of Birth:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
(3) Minor/YouthFull Name:

First NameLast Name
(3) Date of Birth:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
DESIGNATED SUPERVISING ADULT
Full Name:

First NameLast Name
Relationship to Minor:
Phone Number:
Format: (000) 000-0000.
Email:
example@example.com
Organization/Group Affiliation (if applicable):
SCOPE OF AUTHORIZATION
I authorize the Designated Supervising Adult named above to provide reasonable supervision and direction to my child during the approved volunteer activity, including:
- Accompanying and supervising my child throughout the volunteer activity;
- Ensuring that my child follows FirstPres safety rules, volunteer instructions, and site policies;

- Making reasonable decisions regarding my child's participation in specific activities based on safety concerns;
- Accompanying my child if my child needs to leave the immediate volunteer activity area; and
- Contacting me regarding questions, concerns, illness, injury, or other circumstances involving my child.
MEDICAL INFORMATION AND EMERGENCIES
I understand that the Designated Supervising Adult is not a FirstPres staff member and is acting as a volunteer or participant designated by me.

I remain responsible for providing accurate and complete medical information, allergies, medications, emergency contacts, and other information necessary for the safe participation of my child.

I authorize the Designated Supervising Adult to communicate with me regarding my child's medical or emergency needs and, when reasonably necessary, to seek emergency medical assistance for my child if I cannot be reached.

I understand that this authorization does not require the Designated Supervising Adult to provide medical treatment beyond their training or abilities.
RESPONSIBILITY OF PARENT/GUARDIAN
By signing below, I confirm that:
1. I have personally designated the adult identified above to supervise my child.
2. I have provided the Designated Supervising Adult with any information necessary for the safe supervision of my child.
3. I understand that FirstPres staff may provide general direction regarding the volunteer activity and site safety but are not assuming responsibility for the day-to-day supervision of my child.
4. I understand that FirstPres may require my child to discontinue participation if adequate supervision is not available or if safety requirements are not being met.
5. I have communicated with the Designated Supervising Adult regarding the expected responsibilities.
6. The Designated Supervising Adult will remain on site and present with my child during the entirety of my child's volunteer time.
PARENT/LEGAL GUARDIAN
Printed Name:

First NameLast Name
Signature:
Date:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Best Contact Phone:
Format: (000) 000-0000.
Should be Empty:

PARENT/GUARDIAN AUTHORIZATION FOR DESIGNATED ADULT SUPERVISION

MINOR PARTICIPANT(S)

DESIGNATED SUPERVISING ADULT

SCOPE OF AUTHORIZATION

MEDICAL INFORMATION AND EMERGENCIES

RESPONSIBILITY OF PARENT/GUARDIAN

PARENT/LEGAL GUARDIAN