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Biltmore United Methodist Church - YOUTH EVENT CONSENT FORM

I give ____________________________________________________________________

^{Print Youth’s Name}

permission to participate in ___________________________________________________

^{BUMC Youth Activity}

on _______________________________________ .

^Date

___________________________________________________________

^{Parent(s) Signature}

In the event of an illness or accident, which requires immediate medical treatment at a time when a parent/guardian cannot be located, I give permission to Biltmore United Methodist Church to authorize such medical treatment.

I will not hold Biltmore United Methodist Church nor medical personnel responsible. This will be done with the understanding that every attempt will have been made to contact the parents/guardian, the youth’s physician, or other person listed for emergency contact.

__________________________________________________________

^{Print Parent/Legal Guardian’s Name}

__________________________________________________________ _______________________

^{Signature of Parent/Legal Guardian Date}

______________________________________

^{Home Phone Number}

______________________________________

^{Work Phone Number}

______________________________________

^{Cellular Phone Number}

With my signature above, I authorize permission for treatment of above child in the event of an emergency while participating in an activity sponsored by Biltmore United Methodist Church.

_________________________________________________________ _________________________

^{Name of Family Physician Family Physician Telephone Number}

_________________________________________________________ _________________________

^{Insurance Company Name Group or Policy Number}

This consent form shall be used for BUMC youth activities that are held outside of Buncombe County and/or are overnight activities.

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Biltmore United Methodist Church

376 Hendersonville Road

Asheville, NC 28803

PARENTAL CONSENT FORM FOR 2007-2008 BUMC YOUTH PROGRAM PARTICIPATION

To Whom It May Concern:

We the undersigned are the parents, the custodial part of, legal guardian of ________________________, a minor and have given our consent for him/her to participate in Biltmore United Methodist Youth sponsored activities for the 2006-2007 school year (August 2006-August 2007).

In the event of an illness or accident, occurring in the course of participation in a BUMC sponsored activity, every reasonable effort will be made to contact the persons listed on this form. If unsuccessful in contacting the persons listed, consent/permission is given for treatment by competent medical personnel. In the event treatment is called for which a physician and/or hospital personnel refuse to administer without our direct consent, we hereby authorize any adult sponsor representing Biltmore United Methodist Church to give such consent. Preference consideration should be given to the Director of Youth. We agree to hold such person free and harmless of any claims, demands or suits for damages arising from the giving of such consent as long as the treatment is administered by or under the supervision of a licensed physician.

I understand that Biltmore United Methodist Church does not carry medical insurance on people participating in their activities. I agree that my insurance may be used for such medical care expenses. I am aware that the medical provider for any medical treatment expenses not covered by my insurance may bill me. I understand that if I do not have medical insurance coverage that I am responsible for the payment of any medical bills.

Biltmore United Methodist Church assumes no financial responsibility or liability for medical conditions preexisting or incurred while participating in Youth sponsored activities. I, on behalf of myself, my child and for myself and all other persons, hereby release and hold harmless Biltmore United Methodist Church and its adult leaders for any injury, illness, death or other accident that may occur.

Transportation Release: The undersigned does also hereby give permission for our child to ride in any vehicle designated by the adult whose care the minor has been entrusted while attending and participating in activities sponsored by Biltmore United Methodist Church.

Media Release: In signing this document, I also give Biltmore United Methodist Church permission to use photographs or video footage of my child for use on our website or other church publications.

This is the _______ day of _______________________, 200__.

___________________________________________________________________

^{Signature (Participant) –I certify that I am 18 years or older.}

___________________________________________________________________

^{Signatures/Relationship (Parents or Guardians of minor participants).}

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Biltmore United Methodist Church – UMYF

376 Hendersonville Rd.

Asheville, NC 28803

PARENTAL CONSENT FORM

2007-2008 Youth Program Participation

Youth Information

Name __________________________________________ Birth Date ______________

Address _______________________________________Home Phone ____________________

City ______________________________ State __________ Zip Code________________

Parent or Guardian Information

Name __________________________________________ Relationship __________________

Address (if different from above) __________________________________________________

Work Number __________________ Cellular _____________________Pager______________

Name __________________________________________ Relationship __________________

Address (if different from above) __________________________________________________

Work Number __________________ Cellular _____________________Pager______________

Physician & Insurance Information

Insurance Company _____________________________ Policy # ________________________

Group # _____________________

Physician Name _______________________________ Physician Phone __________________

Health Information

(Please check all that apply and explain)

Bladder/kidney problems __________________________________

Heart problems __________________________________________

Asthma ________________________________________________

Seizures _______________________________________________

Diabetes _______________________________________________

Sinus trouble ___________________________________________

Allergies ______________________________________________

Bee sting reactions ______________________________________

Other _________________________________________________

Medications taken regularly _______________________________

Parent or Guardian Signature ______________________________________________________

Date ___________________