St John’s Lutheran Church 2008 GENERAL Permission Forms

                                                                                                                         Date Turned in  ___/___/____

PERMISSION: I hereby give permission for (________________________________) to participate in Youth Group and in all related activities. It is understood that all reasonable caution will be taken by those in charge to prevent injuries, but neither those persons in charge nor St John’s Lutheran Church shall be held responsible in case of accident or death, and I hereby release them from any claims.

It is further agreed that the above youth will abide by the rules and regulations, which may govern each activity and will conduct him / herself in a manner, which is consistent with the Christian faith.

PARENTAL CONSENT FOR TREATMENT:

In the event that I am unavailable for purposes of providing parental consent, I hereby authorize a representative of St John’s Lutheran Church, Maytown, PA, to consent to and authorize the administration and performance of all treatments that may be considered advisable or necessary in the judgment of attending physicians, in the event that the participant should be admitted to any hospital, or be in need of any medical treatment. This authorization shall continue for such time as I am participating in the above youth program and all related activities, or during travel to and from said program.

This consent is valid for 1 year from the date indicated below. A Photostatic or carbon copy of this authorization shall be considered as effective and valid as the original.

Name of Youth _____________________Date of Birth _______ School Attending _______________ Age______  Grade _____ Gender_____

Height: __________ Weight: ___________ Eye Color: _______________Hair Color: _______________

Address __________________________ PO Box ______City ___________ State ________ Zip ______

Mother’s Name ____________________ Phone: Home ___________ Cell __________ Work _________

Father’s Name ____________________  Phone: Home ___________ Cell __________ Work _________

Youth’s E-Mail___________________________ Parent’s E-Mail ________________________________

Check the following areas of concern for this youth. If Necessary, add another page with details:

Does your youth wear   ____ glasses ____ Contact Lenses

For your youth safety and our knowledge, is your youth a---

___ Good Swimmer  ____ Fair Swimmer  ____ Non Swimmer

Physical conditions that the physician should be aware of, Does your youth have allergies to:

Pollens, ______________ Medications, ____________ Food, ____________Insect Bites, _________

Does your youth suffer from, or has ever experienced, or is being treated currently for any of the following:

Recurring, illnesses, _________ disabilities, ________ chronic illnesses, _________asthma, _______

Epilepsy, / seizure disorder,  ________heart trouble _________ physical handicap ___________(ETC)

Current Medications: ___________________________________________________________________

Will they be on the trip with the youth? ___________ Date of last tetanus shot ___________________

Should the youth’s activities be restricted for any reason,  ___ Yes ___ No

I understand that I will be contacted as soon as possible in the event that my child is brought to a hospital or other facility for treatment. If I am not available, please contact:

Emergency contact, name other then Parent, _______________________ Phone No. ______________

Family Physician's Name: _________________ Office Phone: ___________________________

Family Dentist Name: _____________________ Office Phone ___________________________

Insurance Company: _____________________  Policy Number: _________________________

We are St John’s Members ________                    We are not St John’s Members ________

                                                                                    My Student is a friend of _______________________

Parent/Guardian signature: __________________________ Date: ___________________

PLEASE MAKE A PHOTO COPY OF THE MEDICAL CARD (BOTH FRONT AND BACK)

& ATTACH IT TO THIS FORM!

ALL EVENT’S AGREEMENT

The Youth Program of St John’s Lutheran Church, Maytown, Pennsylvania is an intentional Christian Community. In such a community, the behavior of all participants reflects the faith we share in Jesus Christ our Lord.

St John's Youth Group is open to all youth from 1st grade to high school. Some of our youth don't regularly attend Church at St John's. We encourage you to come if you can, but church membership is not a deterrent from your participation in St John's Youth Group. All are welcome.

·  AS A MEMBER OF THE YOUTH MINISTRY PROGRAM OF ST JOHN’S LUTHERAN CHURCH,

WE AGREE to support one another and treat each other in a way consistent with the teachings of Jesus and our church.

·  WE AGREE that when we are in attendance @ any function (Sunday School, Confirmation Activities, Youth group meetings, Off-site activities &/or Retreats) that we will attend and participate in all of the activities of that event.

·  FOR REASONS OF SAFETY AND ACCOUNTABILITY,

  WE AGREE to remain with the youth group for the entirety of all classes, activities, events or retreats, unless accompanied by our advisors. Rough housing or offensive and immodest clothing is prohibited. Tank tops (3 finger rule) are fine, but bellies must be covered (even though the fashion now is to show it off) Shorts and/or skirts need to be long enough and shirts big enough. Guys are not exempt from the dress code. SHIRTS (and shoes) MUST be worn by all at all times. Parents: we need your help in enforcing this police. Our staff cannot do it alone! Modesty is the key word  No fighting, weapons, fireworks, lighters, or explosives

·  WE AGREE that absolutely no tobacco products, alcohol, or drugs (other than prescription drugs) will be brought to or used at class, activities, events &/OR retreats. Prescription Drugs will be registered with the adult advisors

·  WE AGREE to give positive encouragement to fellow youth group members. Respect one another, advisor, staff, and adult leaders. Help others in need. 

·  WE AGREE that when we are on retreat we will conscientiously observe curfew and lights out with the advisors when appropriate.

·  WE AGREE Absolutely no P.D.A. (public displays of affection) of any form. Put your hormones on hold for all events..

·  WE AGREE to be a blessing to others. Disrespect will not be tolerated, a phone call will be made to the parents to pick you up at their expense and you will be returned home. No refunds.

·  WE AGREE THAT WHEN WE ARE ON RETREAT THAT WE WILL NOT ENTER TENTS, CABINS OR ROOMS BELONGING TO OTHER PARTICIPANTS OR ALLOW OTHER PARTICIPANTS TO ENTER OUR TENT, CABINS OR ROOMS (MALE&/OR FEMALE); UNLESS THE DOORS ARE COMPLETELY SECURED OPEN AND AN ADULT IS PRESENT IN THE TENT, CABIN OR ROOM THE ENTIRE TIME!

·  WE UNDERSTAND the privileges of attending classes, activities, events & retreats with St John’s Lutheran Church and the respect of other people, property, the buildings, the organizations rules and the guidelines & the various event activities. Youth who fail to comply with these expectations may be sent home at their parent’s expense.

If something is wrong, tell an advisors, immediately.

THEREFORE, WE UNDER STAND that participants not cooperating or violating this agreement WILL EITHER BE SENT HOME AT PARENTE EXPENCE OR PARENTS WILL BE CONSULTED!            

·  WE WILL STRIVE to help one another keep this covenant!

What to Leave at Home

Your Pet                                  A bad attitude                         All electronic devices              I-Pod, MP3 players etc (with out head seat) 

Cell Phones                             Anything that requires fire to make it work                           Anything else you wouldn’t want to be caught with

Youth Signature_________________________________ Date____________

Parent Rules You are welcome to stay and participate. HOWEVER, if you choose to stay, please remember this is your child’s youth group and we encourage them to do as much as they can for themselves. Keeping in tradition with past youth leaders, when a parent stays they are no longer a parent, but an equal within the group.

Parent/Guardian Signature________________________ Date____________

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 child. I/We 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 the Church. I/We understand that there are inherent risks involved in any ministry or athletic event, and I/we hereby release the Church, 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/our child's involvement. In the event that he/she is injured and requires the attention of a doctor, I/we 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 the Church, I/we agree to hold such person free and harmless of any claims, demands, or suits for damages arising from the giving of such consent. I/We 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/we affirm that the health insurance information provided above is accurate at this date and will, to the best of my/our knowledge, still be in force for the student named above. I/we also agree to bring my/our child home at my/our own expense should they become ill or if deemed necessary by the student ministries staff member.

Permission Form

to publish photos on St Johns Lutheran Website

Our youth webpage (http://www.stjohnsmaytown.com/Youth.htm ) will be a place you will want to visit for forms, calendars, etc. We would also like to include occasional photos of youth in action

WITH OUT NAMING THE YOUTH. Protecting each youth’s privacy and insuring each youth’s safety and well-being will continue to be our first objective!

________ YES, I giver permission for my youth’s photograph to be published on the St Johns Lutheran Website.

________ NO, I do not give permission for my youth’s photograph to be published on the St Johns Lutheran Website.

PARENT SIGNATURE: _________________ DATE: ______________

NAME ___________________________ DATE: _____________

“Our Unity In Christ”