Note To Parent/Guardian: BUMC Youth Ministries wants all of our camps, missions trips, retreats, and events to be safe and healthy ones. However, in the event of an accident or illness, it is important that we have the following information.
Authorization For Treatment/Acknowledgement of Inherent Risk
This information is correct as far as I know, and the person herein described has permission to engage in all Birmingham United Methodist Church Student Ministries related activities except as noted.
I hereby give permission to the medical personnel selected by the staff of Birmingham United Methodist Church to order X-rays, routine tests, treatment; to maintain and/or release any medical records necessary for insurance purposes; and to provide or arrange necessary related transportation for me or my child. In an emergency, I hereby give permission and authorize the physician selected by Birmingham United Methodist Church Student Ministries to secure or administer emergency medical treatment, including hospitalization and any other emergency medical procedures which may be needed for the person named above. I authorize the physician or dentist to call in any necessary consultants in his/her discretion. It is understood that this consent is given in advance of any specific diagnosis or treatment being required, but is given to encourage those persons who have temporary custody of the minor, and said physician or dentist to exercise their best judgment as to the requirements of such diagnosis or medical, dental or surgical treatment. I agree to remain fully liable and responsible for the payment of any such hospital, doctor, ambulance, dental or medical fees. I further agree that in giving this permission and authorization, Birmingham United Methodist Church do not assume any responsibility or liability for the payment of such hospital, doctor, ambulance, dental or other medical fees which may be incurred. The completed forms may be photocopied and maintained by authorized personnel. This form, both front and back, is valid by my permission through December 31, 2018.
Release of Liability
I acknowledge and understand there are inherent risks associated with many Birmingham United Methodist Church Student Ministries activities. I will assume the risk associated therewith, whether known or unknown to me at this time. I recognize that my student’s attendance at a Birmingham United Methodist Church sponsored event is a privilege and as a consideration for this privilege, I release Birmingham United Methodist Church, including its employees, agents and trustees, from responsibility for my student’s accidental physical injury, including death or illness while at a sponsored trip or activity or during travel to and from events. This release is intended to include all claims made by my family, estate, heirs, personal representatives or assigns.
I hereby grant permission to Birmingham United Methodist Church the right to take, use, reproduce, and/or distribute photographs, films, video, and sound recordings of my child, without compensation or approval rights, for use in materials created for purposes of promoting the activities of Birmingham United Methodist Church.
Deposits as Binding
I understand that all deposits made for Birmingham United Methodist Church sponsored events are non-refundable and may or may not be refunded at the discretion of Birmingham United Methodist Church staff. I also understand and acknowledge that by paying a deposit I am making a reservation and committing to paying the total cost of the trip or event. In the event I must cancel that reservation, or if my student does not live up to the required expectations laid forth for that trip, I will pay the remaining balance if Birmingham United Methodist Church is unable to recoup that loss.
Birmingham United Methodist Church leadership reserves the right to send any student home, at your personal expense, in the event that a serious behavioral incident does occur with your son or daughter on any trip or activity. The leadership team will assess the situation, make a decision, call the parent and give options to what action will then take place. Examples may include, but are not limited to, fighting, drug or alcohol use, sexual activity, vandalism, violent behavior, and disobedient behavior.
Minor Medical Care
During Birmingham United Methodist Church sponsored trips or activities, it’s always inevitable that students have minor health and first aid issues. I hereby give permission for Birmingham United Methodist Church and it’s agents to administer the following over-the-counter medication and/or first aid to my child (please check all that apply).