Youth Permission Form

Youth 6th - 12th Grade Permission Form For Local Events
Valid for One Year

Student Name:

Student Birthday: 

Student Medical Needs: 

I give my child permission to drive themselves to local youth outings.     Yes     No
*Student must hold a valid drivers licence, not permit. 

I give my child permission to ride in another car with a youth driver.     Yes     No

Other notes about your child:
 
Parent/Guardian Name:

Emergency Contact Name/Phone Number: 
 
I give my child permission to participate in youth nights on Sundays and Wednesday evenings and activities in the St. Louis area (A separate form will be given for overnight or out of town events) for the calendar year 2017-2018.
 


We have been advised of the nature and extent of the activities that may take place and represent to you that the participant is physically and mentally able to participate in those activities.
 
We understand that activities do present the risk of injury, or even death, to the participant, and we have advised the participant of those possibilities.  We represent to you that we and the participant assume the risk of any such injury or death, and hold you, your agents, employees, volunteers, and representatives harmless from any liability for injury or death to the participant while engaged in this activity, and agree to indemnify and defend you against any claim or liability asserted against you for any such injury or death to participant.
 
We also hold you, your agents, employees, volunteers, and representatives harmless from all liability to any other person or entity arising as a result of the conduct of the participant in this activity and agree to defend and indemnify you, your agents, employees, volunteers, and representatives against any claim, loss, expense, damage, or liability arising as a result of such conduct.
 
If we are not personally present at these activities in which the participant is to participate, so as to be consulted in the case of necessity, you are authorized on our behalf to arrange for such medical and hospital treatment as you may deem advisable for the health and well-being of the participant.

 
 
Parent Signature: