|
This Parent-Guardian Consent and Medical Release form can be used for most of the Lansing Area and Zone ministries activities. This form cannot be used for the following:
Right Of Passage Experience Camps
Michigan Adventure trips
These activities have specific terms that need to be agreed to. The forms for these activities can be found on different pages on this site.
The Parent-Guardian consent and medical release form listed below is for most activities that LAZY provides for our youth.
This form cannot be used for Right Of Passage Camps, or the Michigan Adventure Trip. These two activities have special forms that can be found on this web site.
How to copy and paste the parent/ gaurdian form onto your word processor.
- Left click and hold the cursor at the top and begining of the document below.
- Drag the cursor to the bottom right hand corner of the document.
- Right click on the document, and choose copy.
- Go to your word processor.
- Choose new document on your word processor.
- Right click again, and choose paste.
- Save the document for later use.
- Print it.
**************************************************************************************************************
Lansing Area and Zone Youth: PARENT/GARDIAN CONSENT AND MEDICAL RELEASE FORM
This form is for all activities that require permission from parents and/or guardians of youth 18 years or under except for R. O. P. E. camps.
Lansing Area and Zone Youth Expectations:
* Respect yourself, others and the property of others.
* Follow Leaders instructions.
* Do not use language that is abusive to staff or fellow youth.
* Dress modestly. No bathing suits on canoeing outing. Shorts should be fingertip lengths. No string tops.
Parent/Guardian Wavier/Permission:
Lansing Area and Zone Youth does not discriminate due to race or national origin.
I approve the participation of my minor child in Lansing Area and Zone Youth activity and waive any and all claims against the same, its Officers, Leadership Committee, the Church of the Nazarene, Michigan District Church of the Nazarene, Lansing Zone, due to injury or other damages incurred to the activity participant, or said property to the activity participant in connection to the activity described below.
I assure that my child is in good physical health and is able to attend this activity listed below.
I authorize the Lansing Area and Zone Youth association to render necessary routine first aid and medical care as required. In the event of an emergency, I give permission to the licensed physician chosen by Lansing Area and Zone Youth association to hospitalize, secure treatment, anesthetize or perform surgery for the activity participant named on this form below.
I give permission for Lansing Area and Zone Youth to use my child’s picture (video or photograph) for publicity purposes.
I give permission for _______________________________ (Name of youth) to take part in ________________________ (name of activity) on this day _________(date of activity)
Parents Signature:
Activity Participant Agreement
I agree to abide by all the rules of Lansing Area and Zone Youth.
Participant Signature:
Registration:
Name: ____________________________ Address: ___________________________ E-Mail
City: ______________ State: ___ Zip: _________ Home Phone: ________ Cell: _________
Parent / Guardians(s) Name:
Emergency Contact Information: In an emergency, parents are contacted first. List an additional contact person. Name: _________ _____ Phone: ____ ____
List Medications: _______________________________________________________
List Allergies:
Church Information: Local Church: _____________________
 |
 |
| 
top