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Youth Release Form
Youth Release Form 2024 to 2025 - Up to four children per form.
Address
City, State, and Zip Code
Email Address
Mother's First Name
Mother's Last Name
Primary Phone
Secondary Phone
Father's First Name
Father's Last Name
Primary Phone
Secondary Phone
Emergency Contact
Emergency Phone Contact
Relationship to Child
Physician
Dentist
Insurance Company
Phone
Policy Number
Name of Insured
Although it is our sincere desire to provide a safe environment for your children, we also recognize that accidents can, and sometimes do, happen. While we will still seek to contact you in a life-threatening situation, this form allows us to obtain immediate emergency care for your child in the event we believe it is needed. It also allows us to administer basic first aid and over-the-counter medication (such as ibuprofen, Tylenol, antacids, etc.) to your child if deemed necessary by Maywood staff or appointed volunteers, unless you expressly inform us not to do so in this form. Since trips/activities are arranged for the benefit of those participating, it is understood that Maywood Evangelical Free Church, its employees, and volunteers will execute caution, good judgment, and care but cannot be responsible in case of accident, injury, and loss or damage of property in connection with any trip/activity, and the undersigned will save them harmless from all such claims. You also grant permission to allow your child(ren) to attend Maywood events both on and offsite and to be transported to and from offsite Maywood events with authorized Maywood drivers. I agree to release Maywood Evangelical Free Church, its volunteers and employees, from and against any and all liability, loss, damages, claims or actions to the maximum extent permissible by law, arising out of such transportation. I understand that by allowing my child to participate in this event I am also giving permission for my child’s image to be used in Maywood publications, including on the web, fliers, etc., unless a written request stating otherwise is submitted. The undersigned further agrees to admonish the child participating Maywood programs or events to exercise care, to be well-behaved and in all things obedient to and under the direction and control of those leaders in charge, understanding that failure to do so may result in the child being unable to participate or attend Maywood programs or events. Submitting this form is your electronic signature of agreement.
Today's date
Child #1
Child First and Last Name
Gender
Girl
Boy
Date of Birth
Grade Level
Physical disabilities or limitations
Allergies / other concerns
Date of last tetanus shot
Child #2
Child First and Last Name
Gender
Girl
Boy
Date of Birth
Grade Level
Physical disabilities or limitations
Allergies / other concerns
Date of last tetanus shot
Child #3
Child First and Last Name
Gender
Girl
Boy
Date of Birth
Grade Level
Physical disabilities or limitations
Allergies / other concerns
Date of last tetanus shot
Child #4
Child First and Last Name
Gender
Girl
Boy
Date of Birth
Grade Level
Physical disabilities or limitations
Allergies / other concerns
Date of last tetanus shot
Enter Code
Submit
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Maywood Free Church