ZYG 2020-2021 Annual Permission, Medical & Liability Release Form
Must be completed before student may participate in Youth Events
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My student(s) understand and agree to the following: Wearing a mask during drop off and pick up transitions as well as when in hallways with groups. To sitting socially distant while attending ZYG on Wednesdays and other group meeting times. *
Parent/Guardian Name, Address, Phone #, Email *
Non-Parent Emergency Contact Name & # *
Students Name/Age/Grade/DOB *
Student Contact Info(email or phone) *
Student Gender *
Any Allergies or Special Needs *
2nd Student Name/Age/Grade/DOB
Student Contact Info(email or phone)
Student Gender
Clear selection
Any Allergies or Special Needs
3rd Student Name/Age/Grade/DOB
Student Contact Info(email or phone)
Student Gender
Clear selection
Any Allergies or Special Needs
I DO give consent to Zion Youth Group(ZYG) leader(s) to contact my student(s) via text, individually or included in group text, in regards to Youth Group Ministry *
Required
Is your student(s) covered by medical insurance *
Required
Name of Insurance Provider *
In the event my child becomes ill, is injured, or requires emergency medical attention of any kind, I hereby authorize the adult chaperone(s) to arrange for transportation to the nearest hospital/treatment facility. I give permission for a licensed doctor or healthcare professional to provide any and all medical care they deem, in their professional opinion, to be necessary. I understand that I will assume full responsibility for all medical expenses incurred as a result of the use of this consent. If so, (guardian) please print and date below. *
 The undersigned hereby give(s) permission for our (my) child(ren): to attend and participate in Zion Youth Group(ZYG) events during the 2020-2021 school year. Including but not limited to, weekly meetings, game nights, Food & Faith, retreats, Bible studies, service projects, small groups, mission trips, day trips, student conferences, and more *
Required
In consideration of Zion Church allowing the Participant to participate in Zion Youth Group events, we (I), the undersigned, do hereby release, forever discharge and agree to hold harmless Zion Church, its employees, and its volunteers from any and all liability, claims and demands for accidental personal injury, sickness(Covid-19) or death, as well as property damage expenses, of any nature whatsoever which may by incurred by the Participant(s) while involved in the Zion Youth Group. We (I), the parent(s) or legal guardian(s) of the Participant(s), hereby grant our (my) permission for the Participant(s) to participate fully in events, including trips away from church property. *
Required
Furthermore, we (I), hereby assume all risk of accidental personal injury, sickness(Covid-19), death, damage, and expenses as a result of participation in recreation and work activities involved therein. Authorization and permission is hereby given to Zion Church to furnish any necessary transportation (within the limitation of church insurance and the law), food, and lodging for the Participant(s). The undersigned agree(s) to hold harmless and indemnify Zion Church for any liability sustained by Zion Church as a result of negligent, willful or intentional act of Participant(s), including expenses incurred attendant thereto. *
Required
The undersigned does also hereby give permission for our (my) youth(s) to ride in any vehicle driven by an approved ADULT chaperone while attending and participating in activities sponsored by Zion Church. My child and I understand that SEAT BELTS SHALL BE WORN AT ALL TIMES during transportation. *
Required
Do you give consent to Zion Youth Group(ZYG) to include the Participant(s) name/voice/likeness in promotional photographs and/or videos obtained during any ZYG activities and/or events. *
Required
Parent/Guardian please print and date *
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