BOND Ministry Release Form09.23.20 | by Stephen Haverstick BOND Ministry Release Form Student Name* Activity Permission* Yes No I do hereby certify that my child has permission to participate in all activities from August 31, 2022 through August 31, 2023. Any permissions granted by this form includes Safe-Sanctuary approved transportation. In-House Photo Permission* Yes No I do hereby give FUMC Hershey permission to use my child's photograph in newsletters and slideshows distributed or shown to the congregation at a FUMC Hershey event. Website and Social Media Photo Permission* Yes No I do hereby give FUMC Hershey permission to use my child's photograph on the church website, Facebook page, or Instagram account (understanding that his/her name will not be used). Digital Contact Permission* Yes Only the Youth Director and Children's Director have my permission No I do hereby give the Youth Director, Children's Director, and the Adult Youth Leaders (Small Group Leaders) permission to contact my child via text messages, phone calls, or Zoom calls. Terms and Conditions of Agreement* I have read and agree to these terms and conditions We (I) the parent(s) or legal guardian(s) of this student hereby grant our (my) permission for him/her to participate fully in the events and activities sponsored by or attended by First United Methodist Church of Hershey during the time period of August 31, 2022 through August 31, 2023. Authorization and permission is hereby given to said church (FUMC Hershey) to furnish any necessary transportation, food, lodging, for this participant during the excursions and activities of the BOND ministry program. I understand all safety precautions will be taken at all times by First United Methodist Church and its agents during all events and activities. I understand the possibility of unforeseen hazards and know the inherent possibility of risk. I agree not to hold First United Methodist Church, its leaders, employees, and/or volunteer staff liable for damages, losses, disease, or injuries incurred by the participant who is the subject of this form. Furthermore, I, on behalf of my child, hereby assume all risk of personal injury, sickness, death, damage, and expense as a result of participation in recreation and work activities involved therein. I understand that in the event medical or dental intervention is needed, every attempt will be made to contact immediately the persons listed on this form. In the event I cannot be reached or the alternate contact person cannot be reached in an emergency, I hereby give my permission to a licensed Physician or Dentist at an office or hospital selected by the activity leader to hospitalize, to secure medical treatment and/or to order an examination, injection, x-ray, anesthesia, or surgery for my child as deemed necessary. I understand that First United Methodist Church does not carry accident or medical insurance on participating volunteers. I agree that my insurance company will be used for such medical care expenses. I am aware that I may be billed by the medical provider for any medical treatment expenses not covered by my insurance coverage and that I am responsible for the payment of any medical bills. Parent or Legal Guardian Electronic Signature* Student Signature* Medical ReleaseThe following information input is optional for online submission. If you'd rather submit a hard copy, please print out the form linked at the top right of this page. Insurance Company Policy # Group # Other relevant information about coverage Please list any allergies (food and/or drug) or medical conditions below: Emergency Contact Name Please list the best phone # to reach the above person Parent or Guardian Electronic Signature for Medical Release In the event my child needs medical care, I authorize the adult leaders to secure the needed medical attention for my child. Any permission granted by this form includes transportation time. Please leave this field blank.