PLEASE READ ALL INFORMATION & INITIAL EACH SECTION - YOUR SIGNATURE IS REQUIRED AT THE BOTTOM.
LIABILITY RELEASE AND CONSENT TO TRAVEL
I, being an adult (of 18 years or older) or the parent/legal guardian of named minor, do hereby release Mendham Hills Community Church, its agents, assigns, employees, and volunteer assistants from any liability whatsoever arising out of injury, sickness, damage, or death, which may be sustained by myself or the above minor during any activity, trip, function, or the like-sponsored by or participated in by Mendham Hills Community church from September 2020 through August 2021.
I also give my permission for the above named minor to attend and be transported to any activity, trip, function or the like sponsored by Mendham Hills Community Church from September 2020 through August 2021 by a director or properly appointed adult sponsor of the student ministry of Mendham Hills Community Church.
I, being an adult (of 18 years or older) or the parent/legal guardian of named minor, do hereby give my consent for the youth pastor or properly appointed adult sponsor of the student ministry of Mendham Hills Community church to secure the administration of medical treatment or medication for the above named individual and do further agree to the performance of such treatment, anesthetic, and/or operations, as in the opinion of the attending physician is deemed necessary for myself or the above named minor while at any activity, trip, function, or the like sponsored by Mendham Hills Community Church from September 2020 through August 2021.
I have informed Mendham Hills Community Church of all prescribed or over-the-counter medications that I or my minor are currently taking, all restrictions on medical treatment to be provided, of all allergies to medications and of special medical requirements by listing them on the reverse side of this form.
The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. As a result, federal, state, and local governments and federal and state health agencies recommend social distancing and have, in many locations, prohibited the congregation of groups of people.
Mendham Hills Community Church (MHCC) has put in place preventative measures to reduce the spread of COVID-19; however, the MHCC cannot guarantee that your minor will not become infected with COVID-19. Further, attending the MHCC in-person activities could increase your minor's risk of contracting COVID-19.
By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my minor and I may be exposed to or infected by COVID-19 by attending any MHCC event and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at MHCC may result from the actions, omissions, or negligence of myself and others, including, but not limited to, MHCC employees, volunteers, and program participants and their families.
I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my minor or myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I or my minor may experience or incur in connection with my minor’s attendance at MHCC or participation in MHCC programming (“Claims”). On my behalf, and on behalf of my minor, I hereby release, covenant not to sue, discharge, and hold harmless Mendham Hills Community Church, its employees, agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of MHCC, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any MHCC program.
I, being an adult (of 18 years or older) or the parent/legal guardian of named minor, understand while I or the above named minor participates in any activity, trip, function or the like either sponsored by or participated in by Mendham Hills Community Church from September 2020 through August 2021, I or the above named minor, is responsible to abide by the rules set forth by the sponsored organization, its leaders and/or all supervisory personnel.
Any infraction of rules and/or conduct by the above named person(s), deemed to be serious by any director or properly appointed adult sponsor of the youth ministries of Mendham Hills Community Church, can result in corrective action, up to and including dismissal from the event. In the event that I or the above named minor is dismissed from the program, I or the minor’s legal guardian agree to assume the entire cost of returning home, to forfeit any monies paid for the cost of the trip/event, and to assume responsibility for any monies owed for the cost of the trip/event. I or the above named minor fully understand and agree that there will be no refund of the cost of returning home.
IMPORTANT PARENT INFO
Timely drop off and pick up on Sunday nights and for events is very important for the safety and security of your students, and the respect of our volunteers’ time. Early drop off is not permitted, and prompt pickup is required.
For the safety and security of your students, parents and other adults (with the exception of MHCC staff and official youth leaders) are not permitted to be in the MHCC buildings during youth group. You are welcome, however, to come in at drop off to help your child get acclimated or when you pick them up at the end of the evening/event.
Students may not leave early without parental permission communicated by the parent directly to youth ministry staff or volunteers. Please be specific regarding the time of pickup or departure.
THERE IS ZERO TOLERANCE FOR THE FOLLOWING AT AN MHCC STUDENTS ACTIVITY OR EVENT
Tobacco, alcohol, drug use/possession
Showing up under the influence of alcohol or drugs
Bullying and/or intimidation
CONFIDENTIALITY & REPORTING
In order to promote trust and open dialogue with your student, most things he/she discusses with the youth pastor and youth leaders are kept confidential. If your student is struggling, has a diagnosis, or is in treatment, you are encouraged to talk to the youth pastor about it. Knowledge increases understanding and understanding informs appropriate responses. That said, there are three situations that are NOT kept confidential:
A student threatens to harm or does harm another person or people. Parent(s) will be contacted. If the threat is egregious, the police will be called immediately.
A student threatens to harm himself/herself or is currently harming himself/herself. Parent(s) will be contacted immediately.
A student says that someone is abusing them. In the state of New Jersey, MHCC staff and volunteers are mandated by law to report. There is no room for personal interpretation, and we have no choice, no matter how long we have known the people involved or whether or not they are part of MHCC; Child Protective Services must be called.
Please sign below to acknowledge that you have read and understand the above information. If you have questions, please feel free to contact the youth pastor.
I agree to all of the above statements and all information provided on the reverse of this form is complete, accurate and true to the best of my knowledge.
October 31, 2020