Five:32 Student Information Card

Date

Medical Release: In the event an emergency arises, I authorize Gruene UMC staff or volunteers to give consent for my student to receive life-saving or other necessary medical treatment until I can be reached.

If answer was yes above, please fill in date of consent below.

Date

Legal Release: I acknowledge that I am a parent or legal guardian of the above student and I release Gruene United Methodist Church, its agents, employees, representatives, and volunteer workers from any and all liability if my student is injured during any ministry-sponsored activity.

If answer was yes above, please fill in date of consent below.

Date

Photo Release: I give permission to Gruene UMC to photograph or video my student during any ministry activity and to use such photographs or videos in all forms of media, including crafts, class pictures, videos, slideshows, websites, social media, newsletters, and displays.

If answer was yes above, please give date of consent below.

Date

I give my consent for the person identified above to be transported by Gruene UMC for ministry events and activities.
1. I will not hold Gruene UMC, its officers, agents, employees, assigns or anyone acting on its
behalf, responsible or liable for injury occurring to the named person in the course of such
activities or such travel.
2. I hereby accept financial responsibility for personal items lost by the person identified herein during transport or travel.

If answer was yes above, please give date of consent below. Consent will be valid for all transportation occurring as of and for one year after the below date.

Date

We understand that many young people use digital tools for communication. Therefore, Gruene UMC is requesting your permission to stay in contact with your student via digital communication. Staff and volunteers will only use digital forms of communication when necessary for appropriate ministry related conversation. All persons will be required to follow the safety policy at all times. Please select the boxes below to give permission for that particular form of communication:

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