CedarCreek Student Ministries
Annual Permission / Consent / Liability Release and Student Covenant Form
2016 - 2017 School Year
This form must be completed before any student may participate in any CedarCreek activity or event.
Parent / Legal Guardian Information
(1) Primary Contact - REQUIRED
(2) Secondary Contact
TO WHOM IT MAY CONCERN
The undersigned hereby give(s) permission for the above name participant to attend and participate in CedarCreek Student Ministries activities, events, and retreats during the 2016-2017 school year (from September 1, 2016 to September 1, 2017).
Including, but not limited to:
• Fusion Camp
• Winter Retreat
• Fall Retreat
• Mission Trips
• Santa Bowl
• Flag Football
• Leader trips
• Youth Leadership Summit
• Student Ministry Conferences
In consideration of CedarCreek allowing the Participant to participate in CedarCreek Student Ministries activities, we (I), the undersigned, do hereby release, forever discharge and agree to hold harmless CedarCreek, its directors, employees, volunteers and agents (collectively herein the “Church”) from any and all liability, claims or demands for accidental personal injury, sickness or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by the undersigned and the Participant while involved in the youth activities. We (I), the parent(s) or legal guardian(s) of this Participant, hereby grant our (my) permission for the Participant to participate fully in CedarCreek Student Ministries activities, including trips away from the church premises.
Furthermore, we (I) [and on behalf of our (my) minor Participant(s)] hereby assume all risk of accidental personal injury, sickness, death, damage, and expense as a result of participation in recreation and work activities involved therein. Authorization and permission is hereby given to the Church to furnish any necessary transportation (within the limitations of church insurance and the law), food, and lodging for the Participant. The undersigned agree(s) to hold harmless and indemnify the Church for any liability sustained by the Church as a result of negligent, willful or intentional acts of Participant, including expenses incurred attendant thereto.
MEDICAL TREATMENT PERMISSION:
We (I) authorize an adult, in whose care the minor Participant has been entrusted, to consent to any emergency x-ray examination, anesthetic, medical, surgical or dental diagnosis or treatment and hospital care to be rendered to the minor Participant under the general or special supervision and on the advice of any physician or dentist licensed under the provisions of the Medical Practice Act on the medical staff of a licensed hospital or emergency care facility. The undersigned shall be liable and agree(s) to pay all costs and expenses incurred in connection with such medical and dental services rendered to the aforementioned minor Participant pursuant to this authorization.
EARLY RETURN HOME POLICY:
Should it be necessary for our (my) child or youth to return home due to medical reasons, disciplinary action, or otherwise, the undersigned shall assume all transportation costs and responsibility.
The undersigned does also hereby give permission for our (my) youth to ride in any vehicle driven by an approved ADULT chaperone while attending and participating in activities sponsored by the Church. My child and I understand that SEAT BELTS SHALL BE WORN AT ALL TIMES during transportation.
PHOTOGRAPH / VIDEO PERMISSION:
All photos, videos, and audio tapes of my child captured by CedarCreek Student Ministries is also released to CedarCreek for promotional purposes such as brochures, videos, web pages, etc.
STUDENT COVENANT OF CONDUCT:
My child and I understand that the CedarCreek Student Covenant of Conduct is applicable to the Participant at all times while involved with CedarCreek Student Ministries and the sponsored activities and events. My child and I agree to:
• Recognize that everyone in the group is a part of the body of Christ. I will help everyone feel welcome and important.
• Respect the physical and emotional well-being of others by “doing unto them as I would have them do unto me.” This includes refraining from harsh play or violence, refraining from harmful jokes, respecting the need for sleep, etc.
• Respect the health of my own body by refraining from the use of tobacco, alcohol, illegal drugs and weapons. I understand that the use of these substances is absolutely prohibited. They will be confiscated and parents and/or authorities contacted immediately.
• Respect the things I use and the property of the places I visit. The areas used for all events, including transportation, shall be left clean.
• Participate fully in all scheduled group activities and abide by additional group guidelines made during a special event or trip.
• Act appropriately with members of the opposite sex. This means no couples alone at any time, and no public displays of affection.
• Follow all instructions given by leaders/chaperones without protest. An instruction may be politely and discreetly questioned.
• Stay within the group or assigned sub-group at all times. I will not wander off alone or leave the activity site unless granted permission by an adult, and I will report for all designated check-in times.
• Hold safety in the highest regard, and refrain from compromising my own safety or another’s safety.
dfProvide a trusting environment for my peers. When others share something about themselves in a group discussion, I will not repeat that information outside of the group.
• Take the initiative to inform my guests of their responsibility to follow these guidelines when they visit or participate in an event.
GUIDELINES FOR CONSEQUENCES:
Consequences will focus on restoring peace with reconciliation among the parties involved. The goal of resolving each problem will be growth and learning through repentance and forgiveness. Any problems encountered will be handled within the group and by the adult leaders to the extent that this is possible. However, should a situation persist or become uncontrollable, the parent/guardian will be contacted and informed of the problem. Should the situation be urgent, the parent/guardian will be contacted immediately and will be responsible for picking up the minor Participant from an event or providing for his/her transportation home.
Participant's Medical Information
Parent or Guardian Signature:
My signature on this Annual Permission / Consent / Liability Release and Student Covenant Form is an acknowledgement that I have read and understand these guidelines. I recognize that this is a permission slip, medical release, liability release, and covenant for the 2016 - 2017 school year. I commit to abide by the provisions of this Release Form and submit to CedarCreek’s Student Ministries.