Child and Youth General Release Form Fall 2025

Child/Youth Information

Name

Nickname

Pronouns

Grade

Birthdate

School

Primary Address

Secondary Address

Guardian Information

Guardian Name 1

Cell Phone Guardian 1

Email Guardian 1

This address will receive a confirmation email

Guardian Name 2

Cell Phone Guardian 2

Email Guardian 2

This address will receive a confirmation email

Emergency Contact

Emergency Contact Name 1

Emergency Phone 1

Relationship Emergency Contact 1

Emergency Contact Name 2

Emergency Phone 2

Relationship Emergency Contact 2

Other Important Information about My Child

My child can be picked up by the following persons:

My child has permission to walk home alone

Yes No

List any allergies (drug/medicine, food, and/or environmental) and the severity and type of reaction.

Allergies

Additional comments or concerns regarding my child's safety or any other pertinent information about my child (i.e. physical, behavioral, or emotional) that would be important for the adult leaders to know.

Parental Consent

The undersigned does hereby give permission for my child (“Participant”), to attend and participate in any St. Paul’s United Church of Christ children/youth ministry activities, events, retreats, and childcare from the date the form is submitted until December 31, 2026.

LIABILITY RELEASE: In consideration of St. Paul’s United Church of Christ allowing the Participant to participate in children/youth ministry (Sunday Worship, Sunday School, Confirmation Class, Kids Night Out, Youth Group, Joyful Noise Choir, Messy Church, Activities, Events, Retreats, etc.) and Nursery/Childcare, I, the undersigned, do hereby release, forever discharge and agree to hold harmless St. Paul’s United Church of Christ, its pastors, directors, employees, volunteers, and teachers (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 children/youth activities and childcare. I, the parent or legal guardian of this Participant, hereby grant my permission for the Participant to participate fully in children/youth ministry activities and child care, including trips away from the church premises. Furthermore, I, on behalf of my minor Participant, 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. The undersigned further hereby agrees to hold harmless and indemnify said Church for any liability sustained by said Church as the result of the negligent, willful or intentional acts of said Participant, including expenses incurred attendant thereto.

EARLY RETURN HOME POLICY: Should it be necessary for my child or youth to return home due to medical reasons, disciplinary action or otherwise, the undersigned shall assume all transportation costs and responsibility.

TRANSPORTATION PERMISSION: The undersigned does also hereby give permission for my child/youth to ride in any vehicle driven by an approved and licensed ADULT chaperone while attending and participating in activities sponsored by St. Paul’s United Church of Christ. My child/youth and I understand that SEAT BELTS MUST BE WORN AT ALL TIMES during transportation.

By typing my name on the line below, representing my signature, I agree to the above Parental Consent.

Parent/Guardian Signature

Photo Release for Children and Youth

I agree that St. Paul’s United Church of Christ may photograph and record my and my family members’ (partner and children/dependents, for example) likeness and activities (Images) during church-related activities. I grant the following rights to St. Paul’s United Church of Christ: permission to use and re-use, publish and re-publish, and modify or alter the Image(s) taken during the shoot. Use of the Images for editorial, commercial, trade, advertising, and any other purpose may be done in any medium now existing or subsequently developed, on the church website and on the internet, and worldwide in perpetuity for the purposes stated above. I waive my right to inspect or approve any editorial text or copy that is used in connection with the Images and release and discharge St. Paul’s United Church of Christ from any and all claims arising out of use of the Images for the purposes described above, including any claims for libel, invasion of privacy, or other tortuous act. I have read the foregoing. I fully understand its contents, understand that this agreement does not expire, and confirm my agreement by signing below. I am over the age of 18 and have legal capacity to sign the release by typing my name below.

Yes No

Parent/Guardian Signature

Description

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Child and Youth General Release Form Fall 2025

Description

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