SPY Permission and Release |

SPY Parents,

Please complete this form for each of your children participating in SPY events for the 2016-17 school year.

Thank you,

Dave

SPY Contact, Permission, & Release Form (August 18 to August 19)

This form allows us to gain contact information, gives student parental permission to participate in events, and provides information in case of a medical emergency.

Step 1 of 4

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Mother's Information
Mother's Name

First

Last
Mother's address
Mother's Cell Phone
Mother's Email
Father's Information
Father's Name

First

Last
Father's address
Father's Cell Phone
Father's Email
Emergency Contact

Please provide information of someone other than a parent to contact if parents are not available and their is an emergency.
Emergency Contact Name*

First

Last
Emergency Contact's Relationship to Student*
Emergency Contact Home Phone

Landline
Emergency Contact Cell Phone
Emergency Contact E-mail

Medical Information
Medical Release Liability from August 2018 to August 2019.*
I (We) the parent(s)/legal guardian(s) of the following participant, hereby grant my (our) permission for him/her to participate fully in any activities sponsored by the Youth Ministry of San Pedro Presbyterian Church from August 2018 through and including August 2019.

Authorization and permission is given to San Pedro Presbyterian Church to furnish any necessary transportation, food and/or lodging for participant. Should it be necessary for the participant to return home due to medical reasons, disciplinary action or otherwise, I (we) assume all transportation costs.

I (We) hereby release, forever discharge and agree to hold harmless San Pedro Presbyterian Church and the leaders thereof from any and all liability, claims or demands for personal injury, sickness, death, as well as property damage and expenses incurred by the participant while participating in any San Pedro Presbyterian Church Youth Ministry sponsored activities. Furthermore, I (we) hereby assume all risk of personal injury, sickness, death, damage and expense as a result of participation in recreation and work activities involved therein.

I (We) hereby agree to hold harmless and indemnify San Pedro Presbyterian Church and their leaders for any liability sustained by San Pedro Presbyterian Church as the result of the negligent, willful or intentional acts of the participant, including any and all expenses incurred.

I (We) (being 21 years of age or older) understand that in the event medical intervention is needed, every attempt will be made to contact the persons listed on this form. In the event I cannot be reached in an emergency, I hereby authorize an adult leader, in whose care my (our) child has been entrusted, to consent to the physician or dentist selected by the adult leader to hospitalize, to secure medical treatment and/or to order an injection, anesthesia, X-rays, or surgery for my (our) child as deemed necessary.

Furthermore I (we) hereby give an adult leader with San Pedro Presbyterian Church consent for Emergency Medical Services (911) to be contacted in the event of a medical emergency. I (we) give consent to San Pedro Presbyterian Church for transportation for my (our) child by ambulance if deemed necessary.

I (We) further understand that my (our) insurance coverage for my (our) child will be used as primary coverage in the event medical intervention is needed. Any policy of the church or organization sponsoring this event will be used as the secondary coverage.

I (We) understand all reasonably safety precautions will be taken at all times by San Pedro Presbyterian Church and its agents. I (We) understand the possibility of unforeseen hazards and know the inherent possibility of risk. I agree not to hold San Pedro Presbyterian Church, its leaders, employees, and volunteer staff liable for damages, losses, diseases, or injuries incurred by my (our) child.
- I have read the foregoing and agree to the terms established on this form.
Physician's Name
Physician's Number
Dentist's Name
Dentist's Number
Medical Insurance Company*
Medical Insurance Policy Number*
Please list any and all medical conditions or special circumstances that adults or medical personnel need to be aware:
Please list any regular medications and instructions.
Please list any allergies and medication allergies

SPY Code of Conduct

When attending San Pedro Youth events we represent San Pedro Presbyterian Church, and Jesus Christ to those that we come in contact with. That is why we ask that our students abide by following…
Rules of Conduct:*
No possession or use of alcohol, drugs, or tobacco
– No fighting, fireworks, weapons, lighters, pocket knives
– No offensive or immodest clothing
– Participation with the group is expected at all times
– Respect all of the leaders in charge
– No foul language/jokes or coarse talk
– Respect property, one another, and comply with event schedules

(Youth who fail to comply with these rules will be sent home at their parents/guardians expense.)
- I have read and understand the Rules of Conduct for participation and will abide by them as well as the directions of the leadership of the activities.
Cell Phone Policy

When participating in SPY events we ask that you use cell phones as minimally as possible. We ask this in order to build community with those around us, and avoid distractions from what God or others may be teaching us.
We ask that you follow these cell phone regulations:*
• No cell phone usage during worship, spiritual lessons, camp programs, church services or quiet time.
• While on service project and mission trip work sites, phones can only be used as cameras, and only when appropriate. Please no talking, texting, or posting photos to social media during this time.
• During travel time and free time phones may be used, but only briefly, please make the most of the opportunity to interact with those around you.
• To help maintain privacy and avoid impropriety, phones can only be used as music devices in sleeping rooms, not for phone calls, cameras, texting, or social media.
• If an adult asks you to put the phone away, do so immediately and without complaint. If the phone become a continual distraction, it will be taken away, and returned to your parent.
• You are responsible for your phone if it gets lost, stolen, or broken.
- I have read and agree to follow the cell phone policy:
Bathing Suit Policy

When students are participating in SPY events that require bathing suits, we are asking that you follow the following calls to modesty.
We hope that you will respect our swim suit policy, even if you do not agree with it. Our hope is that our programs are a place where we can safely come and experience the love of Jesus above all else.*
Girls: We are asking all girls to wear a swimsuit that covers their stomach while at youth events. This includes one piece bathing suits, tankinis, or a two piece suit with a t-shirt cover-up.

Guys: We are asking all guys to wear a bathing suit that extends past their fingertips when their arms are at their side.

This call to modesty is because…

1. It creates a safer environment, where fashion and figure do not need to define us.

2. It helps block lustful eyes and helps not objectify those of another gender.
- I have read and agree to follow the bathing suit policy:
Student Signature*

Type name in all caps
Parent Signature*

Type name in all caps
Date Completed*

SPY Contact, Permission, & Release Form (August 18 to August 19)

Step 1 of 4

Student Information

Mother's Information

Father's Information

Emergency Contact

Medical Information

SPY Code of Conduct

Cell Phone Policy

Bathing Suit Policy