Vineyard Student Ministries Parent Permission Form
I, the undersigned parent/guardian of the named child, understand that my child is responsible for the knowing the rules and regulations made by the Duluth Vineyard Church and the sponsors of these activities. I understand that the breaking of these rules could result in the student being sent home at the expense of the guardian/parent.
I hereby authorize the adult leader of this activity to transport the named child to the destination of this event, or to a medical doctor for examination and treatment of any accident or illness that may arise during the term of said activity. I understand that in the event of a medical emergency, every effort will be made to contact the parent/guardian listed. In the event I cannot be reached, I hereby authorize any physician, nurse, medical authority and/or hospital to administer proper treatment for my child. In consideration of this acceptance for said activity, the Vineyard Church (i.e.. staff, leaders, or volunteers) is hereby released and relieved from liability for accident and injury to said child arising from any and all activities of this event.
I have listed all known allergies, immunizations and health problems and any other information pertinent to named child’s health, including all medications named child takes on the Duluth Vineyards Medical Release Form*. Permission is hereby given for my named child’s leader to administer prescription medication as directed on the original prescription medication container. Permission is also hereby given for the staff of the Vineyard Church and/or my named child’s leader to administer generic over-the counter medications (i.e. ibuprofen, aspirin, tums etc...) as directed by the labels provided by the manufacturer for my child:
Dated: August 17, 2022
*We ask parents/guardians to flll out a Medical Release Form for 2017-2018 to ensure exact medical/insurance information. Forms are available at duluthvineyard.org or email email@example.com to receive one via email.