Youth Consent Form

I, the undersigned, being the parent or legal guardian of the youth named above, do hereby consent to the participation of my youth in all the scheduled youth activities of The Pentecostals of The Woodlands of The Woodlands, Texas, and any other supervised activities customarily associated with its youth group, including youth rallies and overnight or weekend youth trips. Further, I certify that my youth is physically fit and adequately prepared to participate in all recreational and sporting events. If I wish to revoke this consent for any reason, I will promptly notify the pastor in writing.

I understand that I will be notified in the case of a medical emergency. However, in the event that I cannot be reached, I authorize the calling of a doctor and the providing of necessary medical services in the event that my youth is injured or becomes ill. I authorize one or more of the following persons to make emergency medical care decisions on behalf of my youth, if required by law or a health care provider: Tim Szumanski, Mindi Szumanski, another adult chaperone designated by the pastor, and

(Note to Parent: you may add or delete a name as desired.) I authorize these persons to act in my place to consent to all necessary and appropriate x-ray examinations, anesthetic, medical or surgical diagnosis or treatment, and hospital care. I understand that The Pentecostals of The Woodlands will not be responsible for medical expenses incurred solely on the basis of this authorization. I further agree to notify the pastor in writing of any health changes that would restrict my youth’s participation in any normal youth activities. I also understand that the pastor and designated adult chaperones reserve the right to restrict my youth from any activity that they do not feel is within the physical capabilities of my youth.

I hereby give my permission for The Pentecostals of The Woodlands (hereinafter called The POW) to use my child or children's videotaped likeness on The POW website, Facebook page, YouTube channel, and in other promotional materials. I hereby grant permission to the rights of my image, likeness and sound of my voice on audio or video tape without payment or any other consideration. I understand that my image may be edited, copied, exhibited, published or distributed and waive the right to inspect or approve the finished product wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of my image or recording. I hereby hold harmless and release The POW from all claims, demands and causes of action which I, my heirs, representatives, executors, administrators or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization. I have read the authorization and release information and give my consent for the use as indicated above.