Medical and Consent FormAsheville Youth Mission (AYM), Asheville NC
With Broad Street Presbyterian Church
June 21-26, 2020
Broad Street Presbyterian Consent
I/We do hereby give permission for my/our child to attend and participate in Asheville Youth Mission summer trip to Asheville, NC from June 21-26, 2020.
In the event of an emergency, I/we do also hereby give permission to the adult leaders as representatives of Broad Street Presbyterian Church to act in my/our behalf to consent to any medical treatment or hospitalization deemed necessary by the leaders and a licensed physician or emergency team. I/We agree to be liable to any and all costs involved in such emergency treatment. I/We release and discharge Broad Street Presbyterian Church and/or representatives involved in this activity from any liability in exercising this permission. The health information on this form is true to the best of my/our knowledge and I/we give permission to the leaders to dispense medications as directed and indicated on this form to my child.
Parent or Gaurdian's Signature:
Participant's Signature (both adult and youth):
Today's Date: March 29, 2020