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Youth Medical Release & Permission Form

Youth  —by stpaulgoldsboro
Youth Medical Release & Permission Form 2026

Youth Information

Parent Information

Any Additional Emergency Contact Information (other than parent)

Medical Insurance Information

Youth Medical Information

If necessary, describe in detail the nature and severity of any physical and/or psychological ailment, illness, propensity, weakness, limitation, handicap, disability, or condition to which your child is subject and of which the Youth Staff should be aware, and what, if any action of protection is required on account thereof. Please list below on this form. All medications and dosages that must be taken on youth trips/retreats MUST BE REPORTED!

Parent/Legal Guardian Consent

I, the undersigned, have legal custody of the child named above, a minor, and have given my consent for him/her to attend events being organized by the Church. I understand that there are inherent risks involved in any ministry or athletic event, and I hereby release the Church, its pastors, employees, agents, and volunteer workers (collectively referred to as the “Church Staff”) 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 medical treatment as deemed necessary by a licensed physician. In the event treatment is required from a licensed medical physician and/or hospital personnel designated by the Church, I agree to hold such person free and harmless of any claims, demands, or suits for damages arising from the giving of such treatment. In the event that a physician and/or hospital personnel refuses to treat without my express consent and all attempts to contact me by phone have been unsuccessful, I give the Church Staff authority to grant my consent on my behalf. In the event it becomes necessary for Church Staff to give consent on my behalf, I agree to hold him/her and the Church free and harmless from and against any and all claims, actions, damages, liability, costs and expenses, including attorney’s fees, that result from injury to person or property or loss of life arising from the giving of such consent, so long as treatment is administered by or under the supervision of a licensed physician and or other professional medical personnel. I further agree that if treatment is administered, I will be responsible for the cost of such treatment. I also agree to bring my/our child home at my/our own expense should they become ill or deemed necessary by the Church Staff. I give authorization for my child’s photograph to be taken during Saint Paul Methodist Church of Goldsboro activities and I authorize for the photos to be published in newsletters, media presentations, websites, or other Saint Paul Methodist Church publications.
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