St John’s Lutheran Church 2009/10 Parental Permission Medical Release Form

                                                                                                                         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 ________________________________

Can we send you E-Mail YOUTH  ___________  Can we send you E-Mail Parent  ___________ 

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 WEAR A SEAT BELT WHEN RIDING IN VEHICLES FOR ANY CHURCH EVENT, 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). Girls must wear either a one piece or a two piece that covers the stomach (i.e., a tankini). If a two piece is worn you will be required to wear a colored (non-white) t-shirt while wearing the swimsuit. Shorts and/or skirts need to be long enough and shirts big enough. Guys are not exempt from the dress code:  Guys swimsuits must be appropriately long and not have any holes. SHIRTS MUST be worn by all at all times. No clothing of any kind with any un-Christian wordage, logos or pictures can be worn. Paints and shorts must be above the hips.  Parents: We need your help in enforcing this policy -- 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 UNDERSTAND 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!

Cell Phones  may only be used during free time. This applies to adults as well as youth unless special permission has been obtained from the event director.

What to Leave at Home

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

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.

Youth Discipline Policy

With in the programs of youth ministry at St Johns Lutheran Church there is a clear goal of encouraging and establishing behaviors that are conducive to meaningful fellowship and Christian expression. This is supported in part by the conduct policy outlined above. Inappropriate behavior diminishes the integrity of the group, discourages participation, and breaks down our support network of volunteers. In an effort to deal with disciplinary problems as efficiently and fairly as possible. The following should be understood as the effective process.

*Failure to comply with these expectations of behavior will be dealt with through the following discipline policies and procedure for the youth program and, if warranted, can result in the immediate contacting of the youth's parent (s) and, if on a trip, possibly be cause for an early return via a commercial carrier (airline or bus) at his/her own expense.

Step 1 – When the behavior first occurs, the adult observing the behavior, or to whom the behavior is reported, shell address the person (s) responsible with a clear request that the behavior be stopped, changed, or avoided. The adult must use judgment as to whether or not the individual (s) knowingly behaved in a manner inconsistent with the policies. The preferred method of changing a person’s behavior is to address specifically what the problem behavior is and what is a preferred option. If a specific person cannot be identified as the one who behaved inappropriately, the entire group of individuals associated with the behavior may need to be addressed. The severity of the problem behavior may require that this step be by passed and the next step be applied.

Step 2 – If another or the same behavior occurs involving the same person (s) above, especially when it is considered to be occurring in a destructive, attention-getting or belligerent fashion, then the observing/reporting adult is asked to bring the individual (s) to the Youth Minister, or a St Johns Lutheran staff member in leadership, for further discipline. If no solution is available, then the leader will proceed to the third step of action, NOTE: Even if the youth (s) agrees to change the behavior at this point, the parent (s) will be notified by the Youth Minister and advised of the situation regarding their child.

Step 3 – Should there be a third problem behavior identified, the parent (s) will be called immediately and ask to come, take custody of the offending youth. A conference will be scheduled for the Youth Minister, parent (s) and the youth(s) involved, to resolve the conflict. This also applies to the breaking of agreements made in step 2. The church leadership reserves the right to send home person (s) who are intentionally oppositional or repeatedly refuse to follow the policies mentioned above for any church event. The parents will be called immediately and asked to assist with arrangements for the return of their youth (s)

With my signature I acknowledge that I have read these policies and agree to carefully abide by them and follow their processes.

Signature of Youth Participant:  _______________________________________  Date:  _______________

Signature of Parent or Legal Guardian:  _________________________________  Date:  _______________

III Church Event Payment Policy

Any youth sponsored event made available through the church youth group requires a deposit of at least 1/3^rd, of  the cost, or posted cost to guarantee a participating youth a spot for the event. In this way the youth group to install some ownership in the event by the youth. Youth will realize that they will forfeit this deposit if they decide at a later date they don’t want to go or if the youth group advisor (s) decides, based on their behavior, they cannot attend. In the past we’ve had youth sign up for an event, but a few failed to go. The result has been that our youth ministry budget has had to cover cost for those who did not follow through on their prior commitments. Every event/mission organization requires a deposit and a group total for each trip we attend. Some event/mission organizations allow groups to drop an individual prior to their deadline, but others do not. Our church cannot continue to pay the costs for youth who choose not to participate in events to which they had committed

We are keeping track of those students who are faithful in their participation in youth group activities and A.L.I.V.E. night. Through their participation they are “earning” the remaining 2/3^rd, of the cost for their event/mission trip. Participation includes but is not limited to, attendance in youth group, Sunday School, and church service as well as participation as a sound technician, Acolyte, Crucifer, Alter care assistant, Usher, Lector, Praise Band member, Choir member, and Hand Bell Choir member, and/or Vacation Bible school staffer, etc. Participation in Crop Walk, fundraisers and assistance in our mission projects are also ways of earning. The mission project is a way of showing God’s grace to less fortunate people who need help and I believe will help to build character in all of us.

Stated below are the church’s youth group procedures for refunding monies received for youth events.

1. Refunds will be available to those who drop out prior to the event/mission organization’s drop deadline (if it exists). All parents and youth will be notified of the church youth groups deadline for deposits and final payments to be made for each church youth group event, and they will also be informed of the event/mission organization’s drop deadline (if it exists).

2. It is the responsibility of the parent (s) to pay the church’s youth group liability for an event if a youth drops out of that event after the dead line.

3. No one will be allowed to attend an event if a deposit or final payment is not paid on time or if prior  arrangements have not been made with the youth minister to provide payment.

4. All deposits and final payments are non-refundable and non-transferable. The only exception to this policy is a serious family emergency verified by a parent (such as a family member passing away prior to the event,) or if an unforeseeable serious illness/injury/wedding that prevents the youth from participating in the event.

5. Deposits and final payments cannot be transferred to siblings or friends and will not be transferred to another church event. Therefore, we encourage all parents and youth to plan ahead and commit and attending  the event being offered before sending a deposit or payment.

With my signature I acknowledge that I have read these policies and agree to carefully abide by them and follow their processes.

Signature of Youth Participant:  _______________________________________  Date:  _______________

Signature of Parent or Legal Guardian:  _________________________________  Date:  _______________

Ministry Permission Form

to publish photos on St Johns Lutheran Website

Our youth webpage (www.stjohnsmaytown.com/ ) 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”

HAVE FUN, BE SMART on Beach Retreat

ST JOHNS LUTHERAN YOUTH GROUP

You are a representative of St Johns Lutheran Church.

Participating in Youth Beach Retreat is a privilege, and students must follow some simple rules while on the Retreat. These rules will be in effect from their departure until their arrival back home at the end of the program.

·         Remember in all 50 states it is illegal to consume alcohol under the age of 21!

·        Personal relationships between couples should reflect a Christian attitude during all youth activities, as well as in the public eye. Absolutely no P.D.A. (public displays of affection) of any form. Put your hormones on hold for all events. You are a representative of St Johns Lutheran Church.

·        Walk through different scenarios and discuss how to handle pressures, including offers of drugs or alcohol and other risky situations.

·        We will figure out a buddy system so that no one person is on the beach, in town or at a party by himself/herself.

·        Stay close to your friends. Three or more people watching out for each other are better than one. Support, protect, and take care of each other.

·        Never allow a friend to go off alone with someone to their apt, condo, house or motel that they’ve just met.

·        Keep gatherings to small numbers and know everyone who is there.

·        Do not announce a party in a large group or in a public place where unwanted guests might overhear.

·        Attend parties where you know the people and have the ability to leave if necessary.

·         Decide ahead of time what you will do if you are in a situation where there is substance or alcohol use.

·        Take along information on alcohol poisoning.

·        Avoid hanging on balcony railings. Every year someone is very severely injured or killed.

·        Know the apt, condo, house or motel address and phone numbers (even if you use cell phones).

·        Swim close to guarded areas. Undertow, riptides, and body surfing in large waves are the cause of rescues and deaths.

·        Watch for warning flags and swimming conditions posted on beaches near life guards.

·        I will stay in OCEAN CITY MD, and not drive or be driven to another beach community/town during the week.

·        Only those persons in our group who have paid a share of the week’s rent will spend the night at the beach house. There will be no overnight guests.

·        If something is broken or damaged, I agree that everyone will pay for it regardless of how it happened or who did it.

·        I agree to leave the house in the same condition it was in when we arrived and participate in its cleanup.

·        As a parent concerned about the health and safety of my child, I pledge that I will not provide him/her, and especially someone else’s child, with alcohol, nor will I support underage drinking parties. Underage drinking can ruin a young life, and I want to be a part of a caring community that says “We do not support underage drinking!”