Sharon Baptist Youth Permission Form 
Permission Form for Sharon Baptist Youth Activities
Date
মিমি
/
মাস
/
বছর
Youth's Name: *
Birthdate *
মিমি
/
মাস
/
বছর
Address *
Home Phone number *
Parent(s)/Custodial Adult(s) Name(s): *
Parent(s)Custodial Adult(s) Cell Numbers: *
Emergency Contact: 
Name, Relationship and Number
 *
Allergies (include Medications youth can NOT take): *
Authorization to obtain Urgent/Emergency Medical Care
As the parent(s) or custodial adult(s) of the youth above, I/we give permission for Sharon Baptist Church, its agents, staff, and volunteers to obtain urgent or emergency medical care for my/our child, and I/we authorize health care providers to render such care as may be necessary. It is understood that reasonable efforts will be made to contact me/us prior to obtaining such care, but I/we authorize such care whether I/we are contacted or not, and I/we agree to be financially responsible for such care. 
Type name(s) if you give consent: 
 *
Medical Insurance Company *
Policy/Group Number *
Participant I.D. Number *
Medical Insurance Phone Number *
Permission to Participate; Release, Waiver of Liability, and Indemnity Agreement
I/we give permission to the youth above to participate in the activities of Sharon Baptist Church, both on the church premises and elsewhere. In consideration of the opportunity of my/our youth to participate in the activities of Sharon Baptist, I/we release Sharon Baptist Church its officers, agents, employees, staff, and volunteers from any and all liability of any kind whatsoever for loss or injury to my/our youth arising from activities on or off the premises of Sharon Baptist Church or resulting from traveling to or from the activities of Sharon Baptist Church, including loss or injury resulting from negligence or gross negligence. 

I/we understand and agree that this permission and agreement shall remain in effect until revoked in writing by me/us, and I/we understand and agree that it is my/our responsibility to update our youth's medical and insurance information as changes occur. 
Sign Name(s) below to give permission: 
 *
Permission to Travel with One Adult Present
I/we give permission for my/our youth to travel in a vehicle operated and occupied by only one adult. 
Type name to give permission
 *
Photo Permission
I/we understand that my youth may be photographed while participating in the activities of Sharon Baptist Church. 
I/we give permission for a recognizable image of my youth to be posted on the SBC Youth website and bulletin boards. I understand that a non-recognizable image, such as a group picture, may be posted. 
Type name(s) to give permission
 *
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