Youth Permission Form

St. Paul's Episcopal Church
Permission Slip & Release of Liability

I, the parent/guardian of the youth(s) name in this form, give permission for the child/children ("participant") to travel with and/or participate in children's and youth activities ("activities") with representatives of St. Paul's Episcopal Church ("St. Paul's") (including, but not limited to, Mother Anne Emry, Father Andy McQuery, Amy Goerger, and Dr. Paul Klemme) ("activity leaders"). 

I understand that the safety and well-being of all participants in these activities will be of the utmost concern to the activity leaders. I understand that the activity leaders will exercise their best judgment under the circumstances and act in good faith. 

I consent to my child/children taking part in activities and I fully understand that some activities may carry a risk of injury, illness, loss, and possible consequent expense for medical, diagnostic, and curative treatments, and incidental loss and expense. 

I, on behalf of myself and heirs, executors, administrators, and assigns, agree that St. Paul's and any St. Paul's staff member, representative, officer, director, employee, or agent shall not be responsible or liable for any personal injury, other injuries, damage, loss, or expense, either to my child/children, my child/children's property, or my property, whether or not such an injury is caused by negligence. 

I represent that my child/children are physically fit to safely participate in activities. Should an accident or other medical emergency occur during the activities, and the responsible St. Paul's staff members are unable to timely reach me for medical authorization I hereby give consent for St. Paul's staff members to authorize necessary hospitalization and medical treatment, including, but not limited to, injections, anesthesia, surgery, and medication. I agree to be responsible for any and all billings and debts incurred with respect to such medical treatment or services. 

I represent to St. Paul's that I am the natural parent or legal guardian of the mentioned child/children, that I consent to the child/children's participation in activities associated with St. Paul's during the year January 2021 to January 2022, and that I agree to abide by the rules and regulations, supervision, and discipline set and applied by St. Paul's and its agents. 

I give my permission for my child to attend functions with St. Paul's during the time period (January 1, 2021-January 1, 2022). I have read and understand the above release of liability and medical authorization and agree to its provisions.

Photo Release
I hereby grant permission to St. Paul’s Episcopal Church, its employees, and the Diocesan staff, to use my child/children’s photograph on its World Wide Web site, bulletin boards/posters, or in St. Paul’s or Diocese of Oregon printed publications without further consideration, and I acknowledge St. Paul’s right to crop or treat the photograph at its discretion. I also acknowledge that St. Paul’s may choose not to use my child/children’s photo at this time, but may do so at its own discretion at a later date.


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