Living Christ Church General Youth & Van Authorization Form

Hello all Please make sure that the first name in the first feild of this form is your Child name and then please click "Add adult" Then as yourself all your inforamtion. If you have any question or concerns please Contact Mary Dzibela Barnhart at Mary@lccnyack.org or Cell number is 203-564-6505

Please add an adult for your Spouse/guardian to your student in this section.
Then please add each child that will be going with us. The first section is for the parent info and this section is for your children who will be coming would be come to Youth Group or any Living Christ function or actives.

Please indicate if your student has any medical history/ needs that they have had in the past and/or currently dealing with. This information that is given in this section is needed in case of a life-threatening or medical emergency, we can give a detailed medical history to medical staff or personnel if deemed necessary. Only need to know personnel will have access to this medical background. All proper HIPAA protocols when taken once we receive this information.

Does your child suffer from, or has ever experienced, or is being treated currently for any of the following? They are please indicate down below by checking the box. Then in the medical Note section please provide detailed information, what your child's condition is, and if they have any medical needs that will need to be taken care of while in our care. If you = indicated other and your child medical condition or illness is not listed, please list it down below in medical notes. If your child takes any medication or will be taking any medication for any reason while in our care please indicate in medical notes below.

Please give detailed information on your child's medical condition or any meditation that will be with their position while in our care. Please as well list and explain any major illnesses the child experienced during the last year:

Behavior policy

At our Living Christ Church youth ministry, we take the safety and well-being of all students seriously. We want to ensure that every student who participates in our events or activities - including youth group, outside church events, and retreats - has a safe, fun, and productive environment. To achieve this, we have established rules and guidelines that all students must understand and agree to comply with. Below, you will find the rules that we expect your student to follow while they are with or at Living Christ Church for any activities:

*No possession or use of alcohol, drugs, or tobacco
*No students can drive to or from events, or drive other student to youth group unless have written consent from their legal guardian.
*No weapons, fireworks, lighters, or explosives
*No boys in girls’ sleeping quarters and no girls in boys’ sleeping quarters
*It is prohibited to leave the group when at a youth group function without leader permission
*No offensive or immodest clothing
*No verbal or physical, nor sexual harassment is permitted while at Living Christ Church functions
*Participation with the group is expected
*Respect property, rules that are expected for that environment
*Respect one another, staff, and adult leaders
*Respect and comply with event schedules
*No pranks that would harm, endanger, or torment themselves or others
*It is prohibited to take others' belongings that do not belong to you. If found guilty, legal action may result.
* Defacing public or private property is strictly prohibited while in care of the Living Christ Church activities. If a student damages (and/or) breaks (and/or) defaces property/ leader vehicle, you will be liable for the cost of repairs of the damages that were made.

It these rules are broken or not follow, up to the youth director discretion of what the punishment may be. Could result in legal action if needed, suspension from youth group or events, sent home on parental or legal guardian diem.

By typing your Full Name (First and Last) you are electorally signing, and understand Living Christ Church, and/or church leaders, and/or youth director can not be held liable if your child is injured, or harmed in anyway. If you child is injured while partaking in any church or youth group activities/function that are held on or off property of Living Christ Church, you will be fully responsible for the cost of medical bills or damages or distraction to property, you will be held legally and financially, liable and responsible for these costs or payment that would need too be made.

By electorally signing this form you are giving your child permission to part take in Living Christ Church Actives and functions, no limitation to any functions or activities.
By electorally signing this form you are giving your child permission and authorization that may take rides in the church van, and /or. a bus, and/or church leader vehicle or/and public transport while at Living Christ Church youth ministry event or activities.

I the parent or legal guardian of the minor, do hereby grant permission for my/our child to participate in Living Christ Church of the CM& of Nyack, sponsored events and specific events, service projects and socials, located on or off of Living Christ Church of the CM&A grounds. I the parent or legal guardian understand that specific event permission forms may be required at a later date in addition to this form. I agree by our mutual electronic signature to release, absolve, indemnify and hold harmless Living Christ Church of the CM&A and any and all supervisors, volunteers, organizers or sponsors thereof, and from any and all liability for injury, medical fees, hospital bills, or doctor bills of aforesaid child. I waive all claims of any kind against any or all of the organizations or persons here In above enumerated, including any and all claims against person or persons transporting aforesaid child to or from any activities here in above named.

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