Youth Ministry Registration ’25–’26

(Includes Medical and Travel Agreements)

Your name *

Email address *

Youth's First Name *

Youth's Last Name *

Birthdate *

Grade *

School *

Allergies

Current Medications

Please describe any medical conditions, concerns, activity limitations, or precautions

Insurance Information

Doctors Name and Phone Number

Medical Agreement

I understand that, in an emergency, every attempt will be made to contact an immediate family member. However, in the event that one cannot be contacted, I request and authorize medical personnel associated with Towson Presbyterian Church and Conference Centers to provide all reasonably necessary medical care for my child including, but not limited to, hospital tests, such as pathology, radiology, anesthesia, surgery, and prescription drugs advisable for the health of my child. I acknowledge that no representations, warranties, or guarantees as to results or cures will be made. I, being the legal guardian or parent of the above attendee, give my consent for emergency medical and surgical treatment in a licensed hospital by a licensed physician should his/her condition require it in my absence. I understand that in such a case, reasonable attempts would first be made to contact me, time and conditions permitting.

Medical Agreement

As long as the medical or surgical treatments considered necessary in the situation is in accordance with generally accepted standards of medical practice for the particular type of injury or illness involved, I impose no specific prohibitions regarding treatment unless stated here:

I understand the above medical agreement *

I authorize church staff to administer either patient or prescription medicine to my child as needed according to instructions on container.

Code of Conduct & Media Use

I have discussed with my child that he/she will not smoke, use drugs, or drink at any time during this activity. My child understands that unacceptable behavior (e.g., cursing, fighting, disrespecting advisors, defacing property) will not be tolerated and may result in dismissal from the activity. I will be available, or will make arrangements, to pick up my child if he/she is asked to leave for unacceptable behavior.

I also understand that Towson Presbyterian Church may use a photograph of my child for such purposes as publicity, illustration, advertising, and social media content. While my child’s photo may not be used immediately, Towson Presbyterian may do so at its discretion at a later date. Names and personal information of my child will not be published with the photograph.

Adult Signature *

Date Signed *

Travel Agreement

By signing below, I acknowledge that this form covers all youth group activities, both off-site and on-site, for the 2025–2026 school year and the summer of 2026, and I give my child permission to travel with TOWSON PRESBYTERIAN CHURCH for the purpose of attending youth activities under the supervision of Joel Strom and/or Whitney Grimm.

I acknowledge that participation in the activity described above involves risk to the Participant (and to Participant’s parents or guardians, if Participant is a minor), and may result in various types of injury including, but not limited to, the following: bodily injury, death, emotional injury, personal injury, property damage and financial damage. In consideration for the opportunity to participate in the activity described above (the “Activity”), the Participant (or parent/guardian if Participant is a minor) acknowledges and accepts the risks of injury associated with participation in and transportation to and from the Activity.

The Participant (or parent/guardian) accepts personal financial responsibility for any injury or other loss sustained during the Activity or during transportation to and from the activity, as well as for any medical treatment rendered to the Participant that is authorized by the Sponsor or its agents, employees, volunteers, or any other representatives (collectively referred to hereinafter as the “Activity Sponsor”). Further, the Participant (or parent/guardian) releases and promises to indemnify, defend, and hold harmless the Activity Sponsor for any injury arising directly or indirectly out of the described Activity or transportation to and from the Activity, whether such injury arises out of the negligence of the Activity Sponsor, the Participant, or otherwise.

I understand the above travel agreement *

Adult Signature *

Date Signed *

A copy of your responses will be sent to your email address.