I, the undersigned, being the parent or legal guardian of the student named above, do hereby consent to the participation of my child in all the scheduled youth activities of RefugeOC church, and any other supervised activities customarily associated with the youth group, including youth rallies and overnight or weekend youth trips. Further, I certify that my youth is physically fit and adequately prepared to participate in all recreational and sporting events. If I wish to revoke this consent for any reason, I will promptly notify the youth leader in writing.

I understand that I will be notified in the case of a medical emergency. However, in the event that I cannot be reached, I authorize the calling of a doctor and the providing of necessary medical services in the event that my child is injured or becomes ill. I authorize an adult chaperone designated by the pastor.

I authorize these persons to act in my place to consent to all necessary and appropriate x-ray examinations, anesthetic, medical or surgical diagnosis or treatment, and hospital care.

I understand that RefugeOC will not be responsible for medical expenses incurred solely on the basis of this authorization. I further agree to notify the youth director in writing of any health changes that would restrict my youth’s participation in any normal youth activities. I also understand that the youth leader and designated adult chaperones reserve the right to restrict my child from any activity that they do not feel is within the physical capabilities of my child.

By signing this document, I release all Youth leaders and staff affiliated with RefugeOC from any and all claims, loss, cost, damage, or expense arising out of or from any accident or other occurrences causing injury to any person or property.

I give permission for my youth to be transported to and from church sponsored activities in a church, rental, or private vehicle.