Merge Student Consent Form*

September 2023-August 2024

*Covers all student (6-12th grades) activities that happen through Clarence Church of Christ. The information received will not be shared outside of internal use.

Student Expectations

 I agree that I am willfully placing myself under the direction and oversight of the youth ministry leadership of the church.** When in attendance, I agree to abide by the articulated guidelines given. I also agree to abide by the following general guidelines: (1) remain present with the gathered group throughout the entirety of the event/activity (unless directed otherwise); (2) use my mobile device(s) in the ways and times permitted and articulated by the leadership; and (3) when riding in any vehicle that is in movement, wearing the seatbelt provided. If any of the articulated guidelines or instructions are breached, I understand that respectful correction may be enacted by the leadership. Appeal to any correction enacted may be directed to the body of elders of Clarence Church of Christ. As a student participant, I agree to the expectations, guidelines, and contents articulated throughout this form.

** The term youth ministry leadership refers to participating paid church staff, adult volunteers (under the oversight of the staff youth minister), and elders (to whom it pertains).

 

Parental Consent

Release of Liability: In consideration for the privilege of allowing my child to participate in Merge, I agree to release and hold harmless the Church, its officers, agents, and volunteers, from any liability to or responsibility for bodily injury, damage or illness to the above-identified child while participating in any youth event or social activity which may be directly or indirectly sponsored by the Church.  Further, I agree to indemnify and hold harmless the Church, its officers, agents, and volunteers with respect to any claim asserted by or on behalf of my child as a result of bodily injury, illness***, or damage.  I recognize that my child may be transported by the officers, agents, or volunteers of the Church, either in the Church van or personal vehicles.  I give permission for this transportation to occur, until I revoke it.  I also agree to release and hold harmless the Church, its officers, agents, and volunteers, from any liability to or bodily injury, damage or illness to the above-identified child that would arise from a transportation-related incident or accident."

Emergency Medical Treatment: I recognize that there may be occasions where this student student may be in need of emergency medical treatment as a result of an accident, illness, or other health condition. Every reasonable effort will be made to contact the parents/guardians listed on this form to inquire of the treatment procedure desired. If unsuccessful in contacting the parents/guardians or emergency contact listed, consent is hereby given to the youth ministry  leadership to authorize competent medical personnel to provide this student with any hospital care, diagnosis, and/or treatment that is needed at that time (under the provisions of the Medical Practice Act on the medical staff of a licensed hospital). I agree to assume all financial responsibility of this medical care (whether through my subscribed insurance program or personal means).

Permission to use media****: I give permission for the youth ministry leadership to use photos/video/sound of this student in church-related publications (i.e., email newsletter, social media, website, promotional material). I also give permission for the church leadership to contact this student via phone, email, text messaging, social media, or other forms of communication for ministry related purposes. I furthermore understand that the church, and it’s leadership, will use these means of communication in appropriate ways.

Consent: As a parent/guardian, I represent and vouch for this student (under 18 years of age). I give permission for this student to participate in the student (6-12th grades) activities of Clarence Church of Christ as described above. I hereby endorse this form, including the Release of Liability above, on behalf of this student, and agree that my endorsement shall be binding upon me.

*** COVID-19 is understood to be highly contagious. By attending an activity sponsored/hosted by the Clarence Church of Christ, participants agree to be mindful of any health guidance and resources provided by the church, and voluntarily assume the risk that you and/or your family may be exposed to or infected by COVID-19 at the church property. Participants agree to assume all the risks of attendance and participation for you and your family, and you waive any liability against the church and any other partnering parties.

**** Photos, videos, audio.