I, (Parent/Guardian named above), grant permission for Youth (named above) to be given over-the-counter medications (i.e. acetaminophen, antacids, ibuprofen) by Carthage United Methodist Church (CUMC) staff or approved volunteers as necessary and directed on the medication label to treat non-emergency medical conditions that do not require treatment at a medical facility while attending and participating in a Youth gathering or event held on or off church grounds sponsored by CUMC.

I, (Parent/Guardian named above) authorize Carthage United Methodist Church (CUMC) staff or approved volunteers, in whose care Youth (listed above) has been entrusted, to render emergency health services of any kind when, in the judgement of a licensed medical professional as defined by Tenn. Code Ann. § 63-6-204, (including but not limited to medical, surgical, dental, psychological or osteopathic practitioners), such services are deemed necessary to perform if essential to the health or life of the aforementioned Youth. I agree to be held liable for any and all costs and expenses incurred in connection with the services rendered to the aforementioned Youth. I consent to the use of an electronic signature in lieu of an original signature on paper.

I, (Parent/Guardian named above), grant permission for Youth (named above) to ride in any vehicle driven by Carthage United Methodist Church (CUMC) staff or an approved and licensed volunteer (age 21 or older) while attending and participating in a Youth gathering or event held on or off church grounds sponsored by CUMC and understand that the aforementioned Youth must wear a seat belt at all times during transportation.

I, (Parent/Guardian named above), agree to not allow Youth (named above) to attend or participate in any Youth gathering or event held on or off church grounds sponsored by Carthage United Methodist Church (CUMC) if they are ill, hereby defined as having a temperature greater than 100.4º or symptoms related to any contagious illness, including but not limited to sneezing/congestion, sore throat, coughing, diarrhea, and vomiting.

In the event that said Youth becomes infected with a contagious illness within 10 days of a gathering or event, I will inform a program leader immediately. I understand that said program leader will contact others who have attended a gathering or event with my child and notify them of said illness, maintaining the Youth's anonymity.

I, (Parent/Guardian named above), hereby release, forever discharge, and agree to hold harmless Carthage United Methodist Church (CUMC), its pastors, directors, employees, volunteers, and teachers (collectively herein the "Church") from any and all liability, claims, or demands for any accidental personal injury, sickness, property damage, expense of any nature, or death as a result of Youth's (listed above) participation in a gathering or event on or off church grounds sponsored by CUMC. On behalf of the aforementioned Youth, I hereby assume all risk of accidental personal injury, sickness, property damage, expense of any nature, or death as a result of Youth's participation in such gathering or event. I consent to the use of an electronic signature in lieu of an original signature on paper.

I, (Parent/Guardian named above), understand that pictures and videos may be taken during Youth gatherings or events, and said visual assets may be posted to the Carthage United Methodist Church (CUMC) website and social media profiles (including but not limited to Facebook and Instagram), as well as via printed mediums (including but not limited to the church newsletter or local newspaper outlets). At no time will Youth be identified by name without first requesting permission from the Parent/Guardian.

https://www.carthagetnumc.org/uploads/1/4/3/5/143519858/cumc_youth_covenant__2023_.pdf

I, (Parent/Guardian named above), understand the terms and expectations set forth by the CUMC Youth Covenant. Should a behavioral issue arise, I understand that the supervising adult(s) are permitted to execute disciplinary action in light of the offense (including but not limited to verbal warnings, restricted activity time, and early return home). I understand that I will assume all transportation costs and responsibilities related to an early return from a gathering or event (including but not limited to medical reasons or disciplinary action). I consent to the use of an electronic signature in lieu of an original signature on paper.

EX. Tucker Huseth (06-13-23)

I, (Parent/Guardian named above), hereby give permission for Youth (listed above) to attend and participate in any Carthage United Methodist Church (CUMC) gatherings or events both on and off church grounds from August 1, 2023 (08/01/2023) through August 1, 2024 (08/01/2024). I certify that I have read, understood, and completed all portions of this release form. 

EX. Tucker Huseth (06-13-23)