My youth has my permission to participate in Youth IMPACT and/or IGNITE at Pine Valley UMC of Wilmington, NC for the 2019-2020 year.
This consent form gives permission to seek whatever medical attention is deemed necessary, and releases the Church and its staff of any liability against personal losses of named youth.
I, the undersigned, have legal custody of the student named above, a minor, and have given our consent for him/her to attend events being organized by Pine Valley UMC. I understand that there are inherent risks involved in any ministry or athletic event, and I hereby release Pine Valley UMC, its pastors, employees, agents, and volunteer workers from any and all liability for any injury, loss, or damage to person or property that may occur during the course of my child’s involvement. In the event that he/she is injured and requires the attention of a doctor, I consent to any reasonable medical treatment as deemed necessary by a licensed physician. In the event treatment is required from a physician and/or hospital personnel designated by Pine Valley UMC, I agree to hold such person free and harmless of any claims, demands, or suits for damages arising from the giving of such consent. I also acknowledge that we will be ultimately responsible for the cost of any medical care should the cost of that medical care not be reimbursed by the health insurance provider. Further, I affirm that the health insurance information provided above is accurate at this date and will, to the best of my knowledge, still be in force for the youth named above. I also agree to bring my child home at my own expense should they become ill or if deemed necessary by the Director of Youth Ministries, event coordinator and/or Pastors.
I understand that, at any time, I can revoke this "release" for specific events or generally.