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PSC YTH Annual Liability Waiver and Medical

Authorization

2026 to 2027 Ministry Year 

This annual form records parent permission, emergency information, medical authorization, and acknowledgement of risk for PSC YTH activities. It becomes effective when signed and remains active through August 31, 2027, unless a parent or legal guardian withdraws or updates it in writing.

This waiver does not register a student for an individual event. Separate online registration is required for each PSC YTH event except approved monthly small-group outings. Parents will receive the details of a monthly outing and must approve their student’s participation.

Permission to Participate

I give permission for the student named in this form to participate in PSC YTH activities during the 2026 to 2027 ministry year, subject to event-specific eligibility, registration, payment, and permission requirements.

Covered Activities

Covered activities may include Sunday YTH, small-group gatherings, classes, service projects, meals, games, recreation, camps, retreats, day trips, overnight trips, and other activities organized or approved by PSC YTH. Activities may occur at Palmetto Shores Church or at approved off-site locations.

Acknowledgement of Risk

I understand that participation may involve ordinary and unexpected risks, including physical exertion, athletic games, recreational activities, food service, public venues, overnight lodging, weather, illness, and transportation. Possible consequences include property damage, illness, emotional distress, bodily injury, disability, or death. I have considered the student’s health and abilities, disclosed relevant information, and voluntarily permit participation.

I understand that PSC YTH cannot eliminate every risk. I will review event-specific information and contact the youth director before an activity if I have questions about safety, accessibility, supervision, transportation, or the student’s ability to participate.

Event Registration

This annual waiver does not reserve a place or grant permission for every event. I understand that PSC YTH requires separate online registration for each event except approved monthly small-group outings. Event registration may include additional schedules, costs, packing instructions, transportation information, health updates, and event specific permissions.

Monthly Small Group Outings

Small-group leaders may arrange one appropriate gathering outside Sunday YTH each month. PSC YTH will provide parents with the date, time, location, supervision, transportation plan, and other relevant details. My student may participate only after I approve the specific outing. This annual form does not replace that approval.

Transportation

Transportation may be provided by a church vehicle, hired carrier, parent, approved adult driver, or another method identified in the event information. PSC YTH will communicate the transportation plan before an event when PSC YTH is arranging transportation. A leader should not transport a student alone unless it is necessary and both the parent or guardian and youth director approve the arrangement in advance through direct communication.

I understand that event-specific transportation permission may be required before my student travels with PSC YTH.

I Agree

Emergency Medical Authorization

If the student becomes ill or injured, PSC YTH will make reasonable efforts to contact the parent or guardian promptly. If the parent or guardian cannot be reached and delay could place the student at risk, I authorize PSC YTH leaders to contact emergency services, arrange emergency transportation, and provide medical personnel with the information in this form.

I authorize licensed medical professionals to evaluate and provide treatment they determine is reasonably necessary for the student’s health and safety, including emergency care. This authorization does not direct a PSC YTH leader to make medical decisions reserved for licensed providers, and it does not authorize routine medication administration.

I accept responsibility for medical, ambulance, hospital, pharmacy, and related expenses not covered by insurance, to the extent permitted by law. I understand that emergency care may be provided under applicable law even when a parent or guardian cannot be reached.

Release of Liability

In consideration for permission to participate, and to the fullest extent permitted by applicable law, I release and hold harmless Palmetto Shores Church and its pastors, officers, employees, agents, and authorized volunteers from claims arising from ordinary negligence connected with the student’s participation in covered PSC YTH activities or authorized transportation.

This release does not apply to gross negligence, recklessness, willful or wanton misconduct, intentional misconduct, or any claim that cannot lawfully be waived. It also does not excuse PSC YTH from following its safety procedures or responding appropriately to an injury or safety concern.

I understand that this section affects legal rights. I have had the opportunity to read the entire form, ask questions, and seek independent advice before signing.

Accuracy and Updates

The information in this form is complete and accurate to the best of my knowledge. 

I Agree

I will notify PSC YTH promptly if contact, medical, allergy, medication, custody, or participation information changes. 

I Agree

I understand that PSC YTH may request updated information or an event-specific medical form when an activity requires it. 

I Agree

Parent Handbook Acknowledgement

I have received or know how to access the PSC YTH Parent Handbook for the 2026 to 2027 ministry year. Pleas email us at luissanchez@psc.church to receive a copy of the handbook.

I Agree

I understand the handbook’s communication, registration, transportation, behavior, boundary, and safety guidance. 

I Agree

Iunderstand that this waiver does not replace direct communication with PSC YTH about a student’s individual needs. 

I Agree

Parent or Guardian Agreement

By signing, I affirm that I am at least eighteen years old and am the student’s parent or legal guardian with authority to give the permissions in this form. I have read and understand this document, and I voluntarily agree to its terms.

Electronic Signature

For an online submission, typing my full legal name and selecting the signature acknowledgement constitutes my electronic signature. I intend it to have the same effect as my handwritten signature.

I agree that my typed name is my electronic signature on this form.

Student Acknowledgement

The student acknowledgement supports clear expectations but does not replace the parent or guardian’s signature.

I understand that I should follow leader instructions, respect other students and leaders, communicate health or safety concerns, and participate in a way that supports a safe environment.

Date: September 26, 2026

Please select who will be participating...
Minor
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First Participant's Name
First Name*
Middle Name
Last Name*
First Participant's Date of Birth*
Date of Birth
Information
Name student goes by
Grade for 2026 to 2027
Parent or Legal Guardian's Preferred contact method

Health and Emergency Information

PSC YTH uses this information only to support the student’s health and safety. Parents must notify PSC YTH when any information changes.

The student has no known medical conditions, allergies, activity restrictions, or accommodations that PSC YTH needs to know about.
The student has information that PSC YTH needs to know about, as explained below.

Medical Conditions and Health Needs


Medical conditions diagnoses or recent injuries

Activity restrictions or needed accommodations

Allergies


Food medication environmental or other allergies

Typical reaction and emergency response instructions

Current Medications

List medications that emergency personnel should know about. Listing a medication here does not authorize a PSC YTH leader to store or administer it.



Medication name and purpose

Dose and usual schedule

Medication During PSC YTH Activities

A separate written medication authorization and clear instructions are required before a leader may store or administer any prescription or nonprescription medication. Medication should remain in its original labeled container. Any student self-carry arrangement must be approved by the parent or guardian and PSC YTH in advance and must follow church policy and applicable law.

The student will not need medication during PSC YTH activities.
The student may need medication during a PSC YTH activity. I will complete the required medication authorization before the activity.

Media Permission

Media permission is optional and is not required for the student to participate in PSC YTH. Select one option. *
YES. I give Palmetto Shores Church permission to photograph, record, edit, and use the student’s image, voice, or creative work in PSC YTH and church communications. These may include the church website, PSC YTH social media, newsletters, printed materials, presentations, and event recaps. PSC will not publish the student’s last name or private contact information with the media unless I give separate permission.
NO. I do not give permission for PSC to intentionally publish identifiable photographs, video, audio, or creative work featuring the student. I understand PSC will make reasonable efforts to honor this selection, although the student may appear incidentally in wide crowd images or livestream backgrounds at public church gatherings. This choice remains in effect through August 31, 2027. I may change it prospectively by contacting PSC YTH in writing. A change does not require PSC to recover material that was lawfully published before the change.
First Participant's Signature*
Parent or Guardian's Email Address
Email*
Confirm Email*
Check to sign up for our monthly Parent Newsletter
Emergency Contact
First Name*
Last Name*
Emergency Contact's Phone Number*
Emergency Contact's Relation to Participant
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*
Relationship*
Phone*
Parent or Guardian's Date of Birth*
Date of Birth
Information
Name student goes by
Grade for 2026 to 2027
Parent or Legal Guardian's Preferred contact method

Health and Emergency Information

PSC YTH uses this information only to support the student’s health and safety. Parents must notify PSC YTH when any information changes.

The student has no known medical conditions, allergies, activity restrictions, or accommodations that PSC YTH needs to know about.
The student has information that PSC YTH needs to know about, as explained below.

Medical Conditions and Health Needs


Medical conditions diagnoses or recent injuries

Activity restrictions or needed accommodations

Allergies


Food medication environmental or other allergies

Typical reaction and emergency response instructions

Current Medications

List medications that emergency personnel should know about. Listing a medication here does not authorize a PSC YTH leader to store or administer it.



Medication name and purpose

Dose and usual schedule

Medication During PSC YTH Activities

A separate written medication authorization and clear instructions are required before a leader may store or administer any prescription or nonprescription medication. Medication should remain in its original labeled container. Any student self-carry arrangement must be approved by the parent or guardian and PSC YTH in advance and must follow church policy and applicable law.

The student will not need medication during PSC YTH activities.
The student may need medication during a PSC YTH activity. I will complete the required medication authorization before the activity.

Media Permission

Media permission is optional and is not required for the student to participate in PSC YTH. Select one option. *
YES. I give Palmetto Shores Church permission to photograph, record, edit, and use the student’s image, voice, or creative work in PSC YTH and church communications. These may include the church website, PSC YTH social media, newsletters, printed materials, presentations, and event recaps. PSC will not publish the student’s last name or private contact information with the media unless I give separate permission.
NO. I do not give permission for PSC to intentionally publish identifiable photographs, video, audio, or creative work featuring the student. I understand PSC will make reasonable efforts to honor this selection, although the student may appear incidentally in wide crowd images or livestream backgrounds at public church gatherings. This choice remains in effect through August 31, 2027. I may change it prospectively by contacting PSC YTH in writing. A change does not require PSC to recover material that was lawfully published before the change.
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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