ONC Youth Group Universal Permission Form

Youth Information

Youth's First Name

Last Name

Birthdate

Gender

Male

Female

Grade

School Name

Home Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Secondary Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Youth Email Address

Youth Phone Number

Parent/ Guardian Information

First Name

Last Name

Parent/Guardian email address

Parent/Guardian Cell Phone

Additional Phone Number

First Name

Last Name

Parent/Guardian Email address

Parent/Guardian Cell Phone

Additional Phone Number

Please list any additional parents or guardians contact info

Emergency Contacts

Would you like us to contact one and/or both parents/guardians FIRST in case of an emergency?

Yes

If no, please explain (if needed)

Please list two other non parent/guardian emergency contacts:

First Name

Last Name

Relationship to Camper

Cell Phone

Additional Phone Number

First Name

Last Name

Relationship to Camper

Cell Phone

Additional Phone Number

Parental Consent

The undersigned does hereby give permission for my child:

Youth's First Name

Youth's Last Name

to attend and participate in any ONC children/youth ministry activities, events, retreats and childcare during the period of January 1, 2025 - June 1, 2025.

LIABILITY RELEASE: In consideration of ONC allowing the Participant to participate in children/youth ministry (Activities, Events, Retreats, Lock-Ins, Trips) and childcare, I, the undersigned, do hereby release, forever discharge and agree to hold harmless ONC, its pastors, directors, employees, volunteers and teachers (collectively herein the "Church") from any and all liability, claims or demands for accidental personal injury, sickness or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by the undersigned and the Participant while involved in the children/youth activities and childcare. I the parent or legal guardian of this Participant hereby grant my permission for the Participant to participate fully in children/youth ministry activities and childcare, including trips away from the church premises. Furthermore, I, on behalf of my minor Participant, hereby assume all risk of accidental personal injury, sickness, death, damage, and expense as a result of participation in recreation and work activities involved therein. The undersigned further hereby agrees to hold harmless and indemnify said Church for any liability sustained by said Church as the result of the negligent, willful, or intentional acts of said Participant, including expenses incurred attendant thereto.

MEDICAL TREATMENT PERMISSION: I authorize an adult, in whose care the minor has been entrusted, to consent to any emergency x-ray examination, anesthetic, medical, surgical, or dental diagnosis or treatment and hospital care, to be rendered to the minor under the general or special supervision and on the advice of any physician or dentist licensed under the provisions of the Medical Practice Act on the medical staff of a licensed hospital or emergency care facility. The undersigned shall be liable and agrees to pay all costs and expenses incurred in connection with such medical and dental services rendered to the aforementioned child or youth pursuant to this authorization.

EARLY RETURN HOME POLICY: Should it be necessary for my child or youth to return home due to medical reasons, disciplinary action or otherwise, the undersigned shall assume all transportation costs and responsibility.

TRANSPORTATION PERMISSION: The undersigned does also hereby give permission for my child/youth to ride in any vehicle driven by an approved and licensed ADULT chaperone while attending and participating in activities sponsored by ONC. My child/youth and I understand that SEAT BELTS MUST BE WORN AT ALL TIMES during transportation. The undersigned further hereby agree(s) to hold harmless and indemnify said church, its directors, employees, and agents, for any liability sustained by said church as the result of the negligent, willful or intentional acts of said participant, including expenses incurred attendant thereto. We (I), hereby grant our (my) permission for my child to participate fully in said trip, and hereby give our (my) permission to take said participant to a doctor or hospital and hereby authorize medical treatment, including but not in limitation to emergency surgery or medical treatment, and assume the responsibility of all medical bills, if any. Further, should it be necessary for the participant to return home due to medical reasons, family emergencies, disciplinary action or otherwise, we (I) hereby assume all transportation costs.

Parent/Guardian First Name

Last Name

Date Signed

Parent's Signature

Youth's First Name

Last Name

Date Signed

Youth's Signature

Medical Information

Primary Care Physician

First Name

Last Name

Physicians Phone Number

Name of Practice

Date of last tetanus shot

Insurance Information

Medical Insurance Company

Insurance Phone Number

Policy/Group ID

Policy Holder's First Name

Last Name

Medications:

List all medications the youth will take during any youth ministry trips, retreats, or events. This includes any prescription, non-prescription medications, herbal supplements, and vitamins. Any participant is required to give ALL MEDICATIONS to the adult youth leader in their original containers with complete dispensing instructions before the start of the event. Youth are not permitted to carry any prescription or non-prescription medication and will be sent home at the parent/ guardian's expense if they do.

Medication Name, Dose, Treatment for, and dispensing instructions

Over the counter medication permission:

Do you give permission for your child/ youth to be given over the counter medication as needed and as directed on the label, to treat non-emergency medical conditions that do not require a doctor or hospital visit such as a minor headache, stomachache, or allergic reaction (i.e. Tylenol, Advil, antacids, Benadryl) while at a youth ministry event?

Choose One:

NO. Contact me or get medical help if my child has any minor medical concerns

YES. I give permission for an adult youth leader to give my child approved over the counter medications as directed on an as needed basis to treat non emergency medical conditions

Parent/ Guardian Signature

Any additional notes you'd like to relay regarding dispensing over the counter medication

Medical Conditions

Please answer in detail if applicable, or write N/A.

List any medical conditions your youth/ child has (asthma, diabetes, epilepsy, etc.)

List any allergies (drug/medicine, food, and/or environmental), and the severity and type of reaction

Please explain any other pertinent information about the participant (i.e. physical, behavioral, or emotional) that would be important for the adult leaders to know.

ONC Photo Release Form for Children and Youth

I agree that Osborne Neighborhood Church may photograph and record my child/dependent's likeness and activities (Images, which means all photographs, film, or other recordings taken of you as part of the shoot) during church-related activities. I grant the following rights to ONC: permission to use and re-use, publish and re-publish, and modify or alter the Image(s) taken during the shoot. Use of the Images for editorial, commercial, trade, advertising, and any other purpose may be done in any medium now existing or subsequently developed, on the church website and on the Internet, and worldwide in perpetuity for the purposes stated above.

I waive my right to inspect or approve any editorial text or copy that is used in connection with the Images and release and discharge ONC from any and all claims arising out of use of the Images for the purposes described above, including any claims for libel, invasion of privacy, or other tortuous act.

I have read the foregoing. I fully understand its contents, understand that this agreement does not expire, and confirm my agreement by signing below. I am over the age of 21 and have legal capacity to sign the release.

Please choose one

YES I give my consent for the photo release

NO I do NOT give my consent for the photo release

Youth's First Name

Last Name

Parent/Guardian's First Name

Last Name

Date Signed

Parent/Guardian Signature

< Back

Next >

Submit

ONC Youth Group Universal Permission Form

Youth Information

Parent/ Guardian Information

Emergency Contacts

Parental Consent

Medical Information

Primary Care Physician

Insurance Information

Medications:

Over the counter medication permission:

Medical Conditions

ONC Photo Release Form for Children and Youth

Join Us This Week!