Student Ministries Medical Release Form 2024-2025

Please take the time to fill out a Medical Release Form for your child in our Student Ministries program. Due to the many details in this form, it is necessary to fill out a separate form for each child. This information helps the student ministry area better serve you and your family. If you have any questions, please reach out to Taylor Ory at taylor@fumc-rr.org.
STUDENT INFORMATION

 
 
 
 
 
 
 
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FAMILY INFORMATION

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Emergency Contact

 
 
HEALTH HISTORY

 
 
 
 
 
 
 
Allergies (enter 'NONE' if not applicable)

 
 
 
 
Pre-existing Conditions

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PRESCRIPTION MEDICATIONS

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
MEDICAL TREATMENT

In the event I am unable to provide information during an emergency, I hereby give permission to the medical professional selected by the church leadership to secure proper treatment, including but not limited to: medical evaluation, medical injection, anesthesia, surgery, and hospitalization for my child as deemed necessary.

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STUDENT RESPONSIBILITY

Each student is expected to follow the rules of conduct below:


        Participation with the group is expected             


        Respect property                                             


        Respect one another, staff, adult leaders           


        Respect and comply with event schedules         


        No foul or abusive language                              


        No breaking any laws


        No possession or use of alcohol, drugs, or tobacco


        No students can drive


        No fighting, weapons, fireworks, lighters, or explosives


        No offensive or immodest clothing


No boys in girl’s sleeping quarters & no girls in boy’s sleeping quarters

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Students who fail to comply with these rules may be sent home at their parents' expense.  I, the student, have read the rules of conduct, and I agree to abide by the stated rules.
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PARENT RESPONSIBILITY

It is the parent’s responsibility to find out all details of youth programs, trip activities, including all Sunday and Wednesday events and Confirmation. Parents are responsible for knowing all details of any off-campus trips, including trip location, departure and return time. Parents are asked to regularly check youth information bulletin boards in the church, e-mails, church website, or call for specific details.
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MEDIA

I hereby GIVE CONSENT for FUMC RR to use photographs, voice recordings, and video recordings (collectively, the “Images”) of my child on the church-wide website, social media, electronic communiqués, displays, and/or in other official printed publications (collectively, the “Church Sponsored Media”) without further request.  I understand that FUMC RR has the opportunity to crop, alter, or treat the Images as it may deem appropriate.  I further acknowledge that FUMC RR may choose not to use Images of my child at this time but may do so at its discretion in the future.  I also understand that once Images are posted on Church Sponsored Media, the image can be downloaded by any computer user, anywhere in the world.
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COMMUNICATIONS

Our Student Ministry Department establishes regular communication with parents and students in a variety of different ways including weekly emails regarding upcoming events and text reminders regarding weekly programming opportunities. To aid in delivering these messages effectively we ask your permission to use the information you have provided in this form to subscribe you and your student (if applicable) to these services with the option to unsubscribe at any point.

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LIABILITY

I have read and understand this form. I certify the above-named student is my child (or under my legal guardianship) and resides with me. I give my consent for him/her to attend and participate in activities, functions, and trips sponsored by First United Methodist Church. I assume all transportation costs, should it be necessary for my child to return home due to medical or disciplinary actions.

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I do hereby release, forever discharge, and agree to hold harmless First United Methodist Church, its staff, leaders, chaperones, and volunteers thereof from any and all liability, claims or demands for personal injury, sickness or death, as well as property damage and expenses of any natures whatsoever which may be incurred while participating in any activity or trip. I assume all risk of personal injury, sickness, death, damage, and expense as a result of participation in recreation and work activities involved therein by my child. I understand by signature that this form is both a binding medical and liability release.

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Description

Please take the time to fill out a Medical Release Form for your child in our Student Ministries program. Due to the many details in this form, it is necessary to fill out a separate form for each child. This information helps the student ministry area better serve you and your family. If you have any questions, please reach out to Taylor Ory at taylor@fumc-rr.org.