Youth Parental Permission Form Please circle which event you are registering for: a.      Quarterly Youth Retreat (Spring, Winter, Fall) b.      Summer Youth Camp ($50 or $45 family friend discount, $60 if attended no fundraisers) c.       Creation Festival d.      Other Event (specify)_____________________________________________________ Students Name:_______________________________________________________________ Students Address:_____________________________________________________________ Parent or Guardians Name:_____________________________________________________ Home Phone Area Code Included:________________________________________________ Emergency Contact Number:____________________________________________________ Birthdate (MM/DD/YY):__________  Students Grade (Circle)  6   7   8   9   10   11   12  First time with our group (Circle)  YES NO    If visitor, who invited you________________________ We do have a licensed and certified Family Practitioner and need to know if you student has any Medical conditions or allergies we should be aware of and medications used: ______________________________________________________________________________ Medical and Liability Release: I __________________________________________, understand that by signing below I am  allowing the staff  of Church on the Rock’s Youth ministry to seek medical treatment for my child if the need arises. By signing below I understand that every attempt will be made to reach me in the event of their need to seek medical treatment for my child, but that the circumstance may arise where they must seek medical consultation and they are unable to reach me. I also understand that by signing below I do not hold the staff of Church on the Rock liable for any accident that might occur while my child is under their care. Rules and Regulations Agreement: It should also be understod that your student will be expected to abide by our "Three-Strikes-Your-Out" policy. This policy helps us maintain order and safety and does not reflect in anyway what we think of your child as an individual. As Christians we strive to accept and love every person for who God created them to be. If they can not obey our simple rules and respect their leaders that have been placed over them, they will be given three warnings. Upon the forth warning they will be sent home, regardless of where our event is located. Since this is our rule and the burden falls upon us to enforce it, we will make arrangements for your childs transportation back to Church on the Rock for pick up by a parent, guardian, or a person you have given us permission to release them to. We do have only three "One-Strike your gone" rules; 1. Caught with drugs or alcohol 2. Caught with a student of the opposite sex in an unsupervised area without staff permission 3.Any offensive violent act towards another student. By signing below, this states you have read this and agree to these terms.   (Parent or Guardian’s signature)___________________________________________________