Youth Permission Form

United Lutheran Church
Youth Activity Permission Slip & Covenant
(please complete all three pages)
Youth Information
First & Last Name: __________________ E-mail: __________________
Home Phone: ___________________ Birth Date: ________ Grade: ___
Address: _____________________________________ Zipcode ______
Parent/Guardian Information
Names: _______________________ E-mail: ______________________
Home Phone: ________________ Cellular Phone(s): _________________
Mother's Work ________________ Father's Work __________________
Emergency Information
Emergency Contact Person (other than parent):_______________________
Home Phone: ___________________ Alternate Phone:_______________
Name and phone # of physician in emergency:_______________________
Health concerns (allergies, medications, etc.):_________________________

This permission form is valid for the following:
(please check all that apply):

__ KICS Events (Grades 2-5) & Family Events
__ JYG Monthly Events (Grades 6-8)
__ SYG Monthly Events (Grades 9-12)
__ S.N.A.C. - Sunday Nights At Church (for JYG & SYG only)
__ Youth Fundraising and Local Service Projects
* Lock-in’s, Retreats, SYNOD Youth Gatherings, National Youth Gatherings, Mission Trips, and other overnight events will require a separate registration form and may require additional information.

As parent or guardian I give permission for my child to participate in the above-described youth group activities associated with United Lutheran Church. I understand that these events will be chaperoned by adult volunteers and/or a church staff member. I will make arrangements for timely transportation home after the given event ends. In the event that I cannot be reached in an emergency, I hereby give my permission to the physician or medical facility selected by my child’s advisor and/or group leader to secure proper treatment for my child as named above.

I hereby give permission to display photographs taken of my child during youth events:
YES ___ NO___ (only first names will be used)

Parent Signature: ___________________________________ Date: ___________
(Please also read & sign the "Youth Covenant" with your child)

___ Check here if you, as a parent, are willing to help with a future youth event or fundraiser.

Youth Covenant
* Your participation in youth activities carries the responsibility of representing all United Youth to the public. You are expected to conduct yourself in a manner that reflects well on your peers as well as yourself. Your contributions to the activities are as important as what you receive from them.

In order to participate in this Christian Community I, __________________, commit myself to the Following guidelines:

1. I will behave in a manner consistent with our Christian faith, refraining from foul language, disruptive behavior and excessive rowdiness (i.e. no name calling, hitting or other rough play will be tolerated). I will treat all peers and adult participants with respect and kindness.

2. I promise to abide by the event schedule and to remain in designated areas, unless permission of sponsors is obtained first.

3. I will be prepared for the various types of activities or events. Examples: Completed permission forms, bring the required amount of money, wear or bring the appropriate form of attire (weather appropriate and church appropriate clothing) and so on.

4. I will respect the property of the church, event sites and other participants. Should damage occur, myself and/or my parents will be responsible for cost of replacement.

5. I understand that it is the church policy that no youth may drive to or from a church-sponsored youth activity if organized transportation is being provided.

6. I understand that all events are tobacco, drug, and alcohol-free and I will not bring or use any of these substances at any church-related activities or events.

7. I agree that displays of personal affection (kissing, etc…) are inappropriate and will not be tolerated.

IN THE EVENT THAT THE ABOVE EXPECTATIONS ARE NOT MET:

1. I will have the opportunity to explain my actions to sponsors in charge.

2. Disruptive behavior will be documented and discussed with my parents and the Pastors

3. I understand that continued disruptions, and/or failure to conduct myself in a way that is in agreement with this covenant may result in expulsion from the activity. My parent/guardian will be contacted, and will be responsible for making arrangements (at parental expense) for me to be picked-up and transported home immediately.

4. Youth not observing #6 and #7 above will result in the individual being removed from the group setting and being sent home at the earliest possible time.

Youth Signature: ______________________________ Date: ___________
Parent Signature: ______________________________ Date: ___________