Activity Consent Form

Consent and Certification
                  I, the undersigned, being the parent or legal guardian of the youth named below, do hereby consent to the participation of my youth in all the scheduled youth activities of Westwood Baptist Church, and any other supervised activities customarily associated with its youth ministry, including weekly youth events, overnight and weekend youth trips.  Further, I certify that my youth is physically fit and adequately prepared to participate in all recreational and sporting events. I also understand that my youth’s picture and/or video could be used in social media or other online formats in a public manner.  If I wish to revoke this consent for any reason, I will promptly notify the ministry leader in writing.  
Medical Treatment Authorization
                  I understand that I will be notified in the case of a medical emergency.  However, in the event that I cannot be reached I authorize calling the emergency contact and the calling of a doctor.   These persons, including the Youth Pastor and adult chaperones, can authorize the providing of necessary medical services in the event that my youth is injured or becomes ill.  If the parent or guardian cannot be reached, I authorize the emergency contact (listed above) and/or doctor to make medical care decisions on behalf of my youth, if required by law or a health care provider. I authorize these persons to act in my place to consent to all necessary and appropriate x-ray examinations, anesthetic, medical or surgical diagnosis or treatment, and hospital care.
                  I understand that the person(s) making such medical decisions for my youth will not be responsible for medical expenses incurred solely on the basis of this authorization.  I further agree to notify the Youth Pastor in writing of any health changes that would restrict my youth’s participation in any normal youth activities.  I also understand that the Youth Pastor and designated adult chaperones reserve the right to restrict my youth from any activity that they do not feel is within the physical capabilities of my youth.
Student Information
Parent Information
Emergency Contact Information
Additional Information

Student Pledge: 
I hereby pledge to uphold all policies of the Youth Ministry of Westwood Baptist Church. During all youth activities and all youth trips, I pledge to follow all instructions of the Youth Pastor and the adult chaperones, including safety instructions.