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- United
Lutheran Church
-
Youth
Activity Permission Slip & Covenant
- (please complete
all three pages)
- Youth
- Name:
________________________
E-mail: ____________________
- Home
Phone: ___________________
Birth Date: ________ Grade:
___
- Address:
__________________________________________________
- Parent/Guardian
- Names:
_______________________
E-mail:
______________________
- Home
Phone: _________________
Cellular Phone: _________________
- 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 events
- (please
check appropriate activities):
-
-
__ Monthly Youth Group
Meetings (JYG & SYG)
-
__ WAC Wednesday’s at
Church (JYG & SYG)
-
__ Fundraising Events
-
__ SYG Monthly Events (Outings)
-
__ JYG Monthly Events
(Outings)
-
__
KICS Monthly Events (Outings)
-
- * Lock-in’s, Confirmation Retreats, NE Middle
School Gathering, National Youth Gathering, Mission Trips, and any
other overnight events will require an additional sign-up form and may
require additional permission forms.
-
- 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 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.
-
- Parent
Signature: _________________________ Date:
_____________
-
- __ Check here
if you as a parent would be willing to help chaperone any of our
events or fundraisers.
- Please list events
below...
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- 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 (hat,
coats, swimsuit, towel, etc.) and so on.
-
- 4.
I will respect the property of the church and other
participants. Should
damage occur, myself and/or my parents will be responsible for cost of
repair/replacements.
-
- 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.
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- IN
THE EVENT THAT THE ABOVE EXPECTATIONS ARE NOT MET:
-
- 1.
I will have the opportunity to explain their actions to
sponsors in charge.
-
- 2.
Disruptive behavior will be documented and discussed with
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: ___________
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