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Seaside Youth Permission Slip

2023-2024


Participant has my permission to attend all activities sponsored by Seaside Community Church from September 1, 2023 to September 1, 2024

I am the parent or legal guardian of the student named above, a minor, and have given our consent for him/her to attend events being organized by the Church, including the event specified above. I understand that there are inherent risks involved in any ministry or athletic event. I voluntarily elect or accept and solely assume all risk of damages and injury incurred or suffered by the student named above while attending events organized by the Church, including the event specified above. I hereby agree not to sue and release the Church, its pastors, employees, agents, volunteer workers, elders, and representatives from any and all liability, claims, damages, and costs for any injury, loss, or damage to person or property that may occur during the course of my/our child’s involvement in events organized by the Church, including the event specified above. I further agree that I shall hold harmless and fully indemnify the parties hereby released from any claims, damages, and costs including attorney fees which may arise from any claim or cause of action made by me, through me or on my behalf even if caused in whole or in part by any of the parties or entities hereby released. In the event that he/she is injured and requires medical attention, I consent to any reasonable medical treatment as deemed necessary by a licensed health professional. In the event treatment is required from a licensed health professional and/or hospital personnel designated by the Church, I agree to hold such person free and harmless of any claims, demands, or suits for damages arising from the giving of such medical care. I also agree to hold harmless and release the Church, its pastors, employees, agents, volunteer workers, elders, and representatives from any and all liability related to expenses arising from the giving of such medical care to the extent those expenses are not reimbursed by my or the student’s health insurances. Further, I affirm that the health insurance information provided above is accurate at this date and will, to the best of my knowledge, still be in force for the student named above at the time of the event specified above. I also agree to bring my child home at my expense should he or she become ill or if a student ministries staff member deems it necessary. I understand that this form does not guarantee my student a spot on the aforementioned trip, rather it enters them in the registration process. I also agree to forgo any money paid for a given event as refunds are only given in case of emergency cancellation (i.e. death in the family, illness).

I ACKNOWLEDGE THAT I HAVE READ AND THAT I UNDERSTAND EACH AND EVERY ONE OF THE ABOVE PROVISIONS IN THIS WAIVER, CONSENT, RELEASE OF LIABILITY AND INDEMNIFICATION AGREEMENT AND AGREE TO ABIDE BY THEM.

Parent/guardian signature:


Date: May 16, 2024

Media Release

Regarding photographs and videos of myself taken at any Seaside Community Church events, I give Seaside Community Church permission to do the following for nonprofit use and without charge: use at the discretion of Seaside Community Church, display at a service or event or be used in a multimedia presentation, reprint and distribute for any SCC non-profit publication with copyright to accompany photo when used (for example, in the Weekly, brochures, etc.), display on the Seaside Community Church website, or use quotes and video clips on the Seaside Community Church website and blog



First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information

Student e-mail *

Student Cell # *

Current Grade: *

Please list any known allergies:

Reaction to allergies:

Level of severity:

Please list any medications taken on a regular basis and what they're treating:
Read below, choose ONE and sign the bottom of the page: *
I allow Seaside's Youth Ministry to use this one permission slip from September 2023 to September 2024. If any information is needed to be corrected and/or change, it is my responsibility to contact the Youth Directors at Seaside.
I would like my student to bring home a permission slip each event for me to sign.

Code of Conduct

For your information, we expect each student to conform to these rules of conduct:
No possession or use of alcohol, drugs or tobacco
No students can drive
No fighting, weapons, fireworks, lighters, or explosives
No offensive or immodest clothing
No boys in girls' sleeping quarters and no girls in boys' sleeping quarters
Participation with the group is expected
Respect property
Respect one another, staff and adult leaders
Respect and comply with event schedules

     Students who fail to comply with these expectations may be sent home at their parents' expense.

I, the student, have read the rules of conduct and the permission to participate in youth group activities.  I agree to abide by the stated personal limitations and code of conduct.

First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

Last Name*
Second Participant's Date of Birth*
Second Participant's Information

Student e-mail *

Student Cell # *

Current Grade: *

Please list any known allergies:

Reaction to allergies:

Level of severity:

Please list any medications taken on a regular basis and what they're treating:
Read below, choose ONE and sign the bottom of the page: *
I allow Seaside's Youth Ministry to use this one permission slip from September 2023 to September 2024. If any information is needed to be corrected and/or change, it is my responsibility to contact the Youth Directors at Seaside.
I would like my student to bring home a permission slip each event for me to sign.

Code of Conduct

For your information, we expect each student to conform to these rules of conduct:
No possession or use of alcohol, drugs or tobacco
No students can drive
No fighting, weapons, fireworks, lighters, or explosives
No offensive or immodest clothing
No boys in girls' sleeping quarters and no girls in boys' sleeping quarters
Participation with the group is expected
Respect property
Respect one another, staff and adult leaders
Respect and comply with event schedules

     Students who fail to comply with these expectations may be sent home at their parents' expense.

I, the student, have read the rules of conduct and the permission to participate in youth group activities.  I agree to abide by the stated personal limitations and code of conduct.

Second Participant's Signature*
Third Participant's Name

First Name*

Middle Name

Last Name*
Third Participant's Date of Birth*
Third Participant's Information

Student e-mail *

Student Cell # *

Current Grade: *

Please list any known allergies:

Reaction to allergies:

Level of severity:

Please list any medications taken on a regular basis and what they're treating:
Read below, choose ONE and sign the bottom of the page: *
I allow Seaside's Youth Ministry to use this one permission slip from September 2023 to September 2024. If any information is needed to be corrected and/or change, it is my responsibility to contact the Youth Directors at Seaside.
I would like my student to bring home a permission slip each event for me to sign.

Code of Conduct

For your information, we expect each student to conform to these rules of conduct:
No possession or use of alcohol, drugs or tobacco
No students can drive
No fighting, weapons, fireworks, lighters, or explosives
No offensive or immodest clothing
No boys in girls' sleeping quarters and no girls in boys' sleeping quarters
Participation with the group is expected
Respect property
Respect one another, staff and adult leaders
Respect and comply with event schedules

     Students who fail to comply with these expectations may be sent home at their parents' expense.

I, the student, have read the rules of conduct and the permission to participate in youth group activities.  I agree to abide by the stated personal limitations and code of conduct.

Third Participant's Signature*
Fourth Participant's Name

First Name*

Middle Name

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information

Student e-mail *

Student Cell # *

Current Grade: *

Please list any known allergies:

Reaction to allergies:

Level of severity:

Please list any medications taken on a regular basis and what they're treating:
Read below, choose ONE and sign the bottom of the page: *
I allow Seaside's Youth Ministry to use this one permission slip from September 2023 to September 2024. If any information is needed to be corrected and/or change, it is my responsibility to contact the Youth Directors at Seaside.
I would like my student to bring home a permission slip each event for me to sign.

Code of Conduct

For your information, we expect each student to conform to these rules of conduct:
No possession or use of alcohol, drugs or tobacco
No students can drive
No fighting, weapons, fireworks, lighters, or explosives
No offensive or immodest clothing
No boys in girls' sleeping quarters and no girls in boys' sleeping quarters
Participation with the group is expected
Respect property
Respect one another, staff and adult leaders
Respect and comply with event schedules

     Students who fail to comply with these expectations may be sent home at their parents' expense.

I, the student, have read the rules of conduct and the permission to participate in youth group activities.  I agree to abide by the stated personal limitations and code of conduct.

Fourth Participant's Signature*
Fifth Participant's Name

First Name*

Middle Name

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information

Student e-mail *

Student Cell # *

Current Grade: *

Please list any known allergies:

Reaction to allergies:

Level of severity:

Please list any medications taken on a regular basis and what they're treating:
Read below, choose ONE and sign the bottom of the page: *
I allow Seaside's Youth Ministry to use this one permission slip from September 2023 to September 2024. If any information is needed to be corrected and/or change, it is my responsibility to contact the Youth Directors at Seaside.
I would like my student to bring home a permission slip each event for me to sign.

Code of Conduct

For your information, we expect each student to conform to these rules of conduct:
No possession or use of alcohol, drugs or tobacco
No students can drive
No fighting, weapons, fireworks, lighters, or explosives
No offensive or immodest clothing
No boys in girls' sleeping quarters and no girls in boys' sleeping quarters
Participation with the group is expected
Respect property
Respect one another, staff and adult leaders
Respect and comply with event schedules

     Students who fail to comply with these expectations may be sent home at their parents' expense.

I, the student, have read the rules of conduct and the permission to participate in youth group activities.  I agree to abide by the stated personal limitations and code of conduct.

Fifth Participant's Signature*
Sixth Participant's Name

First Name*

Middle Name

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information

Student e-mail *

Student Cell # *

Current Grade: *

Please list any known allergies:

Reaction to allergies:

Level of severity:

Please list any medications taken on a regular basis and what they're treating:
Read below, choose ONE and sign the bottom of the page: *
I allow Seaside's Youth Ministry to use this one permission slip from September 2023 to September 2024. If any information is needed to be corrected and/or change, it is my responsibility to contact the Youth Directors at Seaside.
I would like my student to bring home a permission slip each event for me to sign.

Code of Conduct

For your information, we expect each student to conform to these rules of conduct:
No possession or use of alcohol, drugs or tobacco
No students can drive
No fighting, weapons, fireworks, lighters, or explosives
No offensive or immodest clothing
No boys in girls' sleeping quarters and no girls in boys' sleeping quarters
Participation with the group is expected
Respect property
Respect one another, staff and adult leaders
Respect and comply with event schedules

     Students who fail to comply with these expectations may be sent home at their parents' expense.

I, the student, have read the rules of conduct and the permission to participate in youth group activities.  I agree to abide by the stated personal limitations and code of conduct.

Sixth Participant's Signature*
Seventh Participant's Name

First Name*

Middle Name

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information

Student e-mail *

Student Cell # *

Current Grade: *

Please list any known allergies:

Reaction to allergies:

Level of severity:

Please list any medications taken on a regular basis and what they're treating:
Read below, choose ONE and sign the bottom of the page: *
I allow Seaside's Youth Ministry to use this one permission slip from September 2023 to September 2024. If any information is needed to be corrected and/or change, it is my responsibility to contact the Youth Directors at Seaside.
I would like my student to bring home a permission slip each event for me to sign.

Code of Conduct

For your information, we expect each student to conform to these rules of conduct:
No possession or use of alcohol, drugs or tobacco
No students can drive
No fighting, weapons, fireworks, lighters, or explosives
No offensive or immodest clothing
No boys in girls' sleeping quarters and no girls in boys' sleeping quarters
Participation with the group is expected
Respect property
Respect one another, staff and adult leaders
Respect and comply with event schedules

     Students who fail to comply with these expectations may be sent home at their parents' expense.

I, the student, have read the rules of conduct and the permission to participate in youth group activities.  I agree to abide by the stated personal limitations and code of conduct.

Seventh Participant's Signature*
Eighth Participant's Name

First Name*

Middle Name

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information

Student e-mail *

Student Cell # *

Current Grade: *

Please list any known allergies:

Reaction to allergies:

Level of severity:

Please list any medications taken on a regular basis and what they're treating:
Read below, choose ONE and sign the bottom of the page: *
I allow Seaside's Youth Ministry to use this one permission slip from September 2023 to September 2024. If any information is needed to be corrected and/or change, it is my responsibility to contact the Youth Directors at Seaside.
I would like my student to bring home a permission slip each event for me to sign.

Code of Conduct

For your information, we expect each student to conform to these rules of conduct:
No possession or use of alcohol, drugs or tobacco
No students can drive
No fighting, weapons, fireworks, lighters, or explosives
No offensive or immodest clothing
No boys in girls' sleeping quarters and no girls in boys' sleeping quarters
Participation with the group is expected
Respect property
Respect one another, staff and adult leaders
Respect and comply with event schedules

     Students who fail to comply with these expectations may be sent home at their parents' expense.

I, the student, have read the rules of conduct and the permission to participate in youth group activities.  I agree to abide by the stated personal limitations and code of conduct.

Eighth Participant's Signature*
Ninth Participant's Name

First Name*

Middle Name

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information

Student e-mail *

Student Cell # *

Current Grade: *

Please list any known allergies:

Reaction to allergies:

Level of severity:

Please list any medications taken on a regular basis and what they're treating:
Read below, choose ONE and sign the bottom of the page: *
I allow Seaside's Youth Ministry to use this one permission slip from September 2023 to September 2024. If any information is needed to be corrected and/or change, it is my responsibility to contact the Youth Directors at Seaside.
I would like my student to bring home a permission slip each event for me to sign.

Code of Conduct

For your information, we expect each student to conform to these rules of conduct:
No possession or use of alcohol, drugs or tobacco
No students can drive
No fighting, weapons, fireworks, lighters, or explosives
No offensive or immodest clothing
No boys in girls' sleeping quarters and no girls in boys' sleeping quarters
Participation with the group is expected
Respect property
Respect one another, staff and adult leaders
Respect and comply with event schedules

     Students who fail to comply with these expectations may be sent home at their parents' expense.

I, the student, have read the rules of conduct and the permission to participate in youth group activities.  I agree to abide by the stated personal limitations and code of conduct.

Ninth Participant's Signature*
Tenth Participant's Name

First Name*

Middle Name

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information

Student e-mail *

Student Cell # *

Current Grade: *

Please list any known allergies:

Reaction to allergies:

Level of severity:

Please list any medications taken on a regular basis and what they're treating:
Read below, choose ONE and sign the bottom of the page: *
I allow Seaside's Youth Ministry to use this one permission slip from September 2023 to September 2024. If any information is needed to be corrected and/or change, it is my responsibility to contact the Youth Directors at Seaside.
I would like my student to bring home a permission slip each event for me to sign.

Code of Conduct

For your information, we expect each student to conform to these rules of conduct:
No possession or use of alcohol, drugs or tobacco
No students can drive
No fighting, weapons, fireworks, lighters, or explosives
No offensive or immodest clothing
No boys in girls' sleeping quarters and no girls in boys' sleeping quarters
Participation with the group is expected
Respect property
Respect one another, staff and adult leaders
Respect and comply with event schedules

     Students who fail to comply with these expectations may be sent home at their parents' expense.

I, the student, have read the rules of conduct and the permission to participate in youth group activities.  I agree to abide by the stated personal limitations and code of conduct.

Tenth Participant's Signature*
Participant's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*

Confirm Email*
Additional Information

Mother's name

Cell Phone #

Father's name

Cell Phone #

Insurance co. *

Policy # *

Group #: *

Insurance co. phone #: *

Physician *

Office phone #: *
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information

Student e-mail *

Student Cell # *

Current Grade: *

Please list any known allergies:

Reaction to allergies:

Level of severity:

Please list any medications taken on a regular basis and what they're treating:
Read below, choose ONE and sign the bottom of the page: *
I allow Seaside's Youth Ministry to use this one permission slip from September 2023 to September 2024. If any information is needed to be corrected and/or change, it is my responsibility to contact the Youth Directors at Seaside.
I would like my student to bring home a permission slip each event for me to sign.

Code of Conduct

For your information, we expect each student to conform to these rules of conduct:
No possession or use of alcohol, drugs or tobacco
No students can drive
No fighting, weapons, fireworks, lighters, or explosives
No offensive or immodest clothing
No boys in girls' sleeping quarters and no girls in boys' sleeping quarters
Participation with the group is expected
Respect property
Respect one another, staff and adult leaders
Respect and comply with event schedules

     Students who fail to comply with these expectations may be sent home at their parents' expense.

I, the student, have read the rules of conduct and the permission to participate in youth group activities.  I agree to abide by the stated personal limitations and code of conduct.

Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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