Youth Permission Form

Youth Permission Form

Lewis University - Romeoville, IL

GENERALPERMISSIONFORM

I request that my child, , be allowedtoparticipateinthe“Engaging Stories”event, locatedatLewis Universityfrom June 9-16, 2018. Ihereby releaseandindemnifyLewis University, its staff,volunteers,from anyand allliability arisingfromclaimsofanykindornaturewhatsoeverfrommychild's participationinthisevent.

VideotapingandStillPhotographs

Videoandstillphotographs maybetakenduringthisevent.This authorizationformconstitutespermissionformychild'sparticipation inthevideotapeand/orstillphotographs,whichmaybeusedfor future Lewis promotionalefforts.

Code of Behavior

YouarerepresentingLewis Universityduringthisevent andweexpectyouwillrepresentuswell.Weexpectthatyouwill displaymatureandresponsiblebehavior,whichformanyyearshas beenthetrademarkof youthandadults. SomeExpectations:

1. Allparticipantsareexpectedtoarriveontime .

2.Allparticipantsareexpectedtodemonstratecommoncourtesy andrespectatalltimes.Inappropriatelanguage/behaviorwill notbetolerated.

3. Socializingshouldalwaysbedoneinpublicareas.

4.Dressshouldreflectthevalueofmodesty.Writingonclothing shouldreflectChristianvalues.

5.The possession or consumptionof any alcoholic beverage and/orpossession/useofanyillegaldrugisnotpermitted.

6. Smokingisnotpermitted.

7. Weaponsand/ordrugparaphernaliaarenotallowed.

8.Ifundertheageof18,prescriptiondrugsneedtobegiventoan adultleaderforstorageanddistribution.

9.Infractionoftheserulescanmeanimmediatedismissalwithno refund.Participantswillberesponsibletolocalauthoritiesas

well.

Iunderstand andagreetothisCodeofBehavior.Ialsounderstand andagreethatatthetimeofaninfractionrequiringmydismissal,I amresponsible formyremovalfromthepremisesandanycosts involved.

Ifundertheageof18,Ialsounderstandandagreethatmyparents orguardianwillbenotifiedatthetimeofaninfractionrequiring my dismissal. Myparentsorguardianwillberesponsibleformyremoval

fromthepremisesandanycostsinvolved.

MEDICAL PERMISSION FORM

IgrantpermissionfortheadministrationofFirstAidtomychild,

, by the people in chargeofthe“Engaging Stories” event,andthose transportingmychildtoandfromtheeventastheirjudgmentdeems advisable, and to make the necessary referrals to qualified physicians forthetreatmentofillnessoraccidentsofamoreserious nature. IunderstandIwillbepromptlynotifiedintheeventofany seriousillnessoraccidentandpriortoanymajorsurgery, except whendelayinsuchcommunicationwouldendangerlife. Inthecase ofamedicalemergency,Iunderstandthateveryeffortwillbemade tocontacttheparent/guardianoftheparticipant. IntheeventthatI cannotbereached,Iherebygivepermission tothephysicians selectedbytheadultstafftohospitalize,secure propertreatment for, andtoorderinjection,anesthesia,orsurgeryifdeemednecessary formychild.

Cell #

Participant’sName:

BirthDate:

ParticipantParent’sName(s):

Parent’sPhone#(s):

Allergictomedication/other? NOYES (circleone) IfYES,pleasedescribe:

Medication(s)presentlytaking:

Other allergies?

INSURANCE INFORMATION

Policyinthenameof:

InsuranceCompany:

PolicyNumber:

Authorized Physician:

Phone#:

If parent(s)can’tbereached

Teen Signature: Date

Parent Signature: Date