Medical Authorization Form

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We are excited to have your child participate in Cedar Mill Christ UMC's youth group! Please fill out this form for the 2022-2023 school year, ending August 31, 2023.

My child may travel during events by church vehicle or automobile driven by an adult chaperone/leader who is age 21 or over with a valid driver's license. *

Yes

I prefer to give permission for specific events.

I grant permission for my child to receive emergency medical care if necessary. I give the adult chaperones/leaders the authority to act on my behalf with respect to my child's health and safety while with the youth group with the understanding that I or the emergency contact listed will be contacted as soon as possible should the need arise. I accept full responsibility for any expenses incurred providing medical treatment for my child. *

Yes

I release Cedar Mill Christ UMC and its representatives from liability in the event of accidental injury, illness, or death. *

Yes

I grant Cedar Mill Christ UMC permission to use photographs of my child for any legal use, including but not limited to publicity, illustration, advertising, and web content. *

Yes

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