Youth Consent Form

Youth Consent Form

General Contact Information

Parent or Guardian's Address

Medical Information

Consent and Certification

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.

Medical Treatment Authorization

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.

Photography Consent

I understand that my child(ren) whose name is listed above may be photographed at the youth events or activities. I understand that these photographs may be used in promoting youth and POW-related events, either in print or on the Internet.