This form must be completed and signed by a Parent/Guardian for any student who wants to participate in any Newport Church Youth Ministry Activity. This form will be kept on file with the Youth Office and will be valid for a period of one (1) calendar year from the date on this form. It is the responsibility of the undersigned Parent/Guardian to inform the Youth Staff at Newport Church of any changes to the student’s personal or medical information.
The undersigned(s) being lawful parent(s) and/or guardians) of the above-named student (the “Student”), hereby consents to the participation by the student in all Newport Church activities.
The undersigned hereby further authorizes any of the staff, employees, volunteers, directors and agents of Newport Church to provide for, approve and authorize any health care at any hospital, emergency room, doctor’s office or other institution; employ any physicians, dentists, nurses, or other person whose services may be needed for such health care; review and if necessary disclose the contents of any medical records; execute any consent form required by medical, dental or other health authorities incident to the provision of medical, surgical or dental care to the Student. Health care shall include but not be limited to the administration of anesthesia, x-ray examination, performance of operations, diagnostic and other procedures.
If there is no medical emergency, the guardian will first use reasonable efforts to contact the parent(s)/guardians before administering or authorizing any treatment.
The undersigned further acknowledges that any Newport Church activity may include Student being transported in a personal vehicle, a van or a bus and that those drivers will possess a valid driver’s license and insurance.
The undersigned assumes all risk of injury or harm to the Student associated with participation in the Youth Ministry activities and agrees to release, indemnify, defend and forever discharge Newport Church and its staff, employees, volunteers, directors and agents of and from all liability, claims, demands, damages, costs, expenses, actions and causes of action (collectively, the “Claims”) in respect of death, injury, loss or damage to the Student or by the Student, howsoever caused, arising or to arise by reason of or during the Student’s participation in the activity.
This Consent Form may be revoked by parent(s)/guardian(s) at any time before the expiration date with written notice to Newport Church.