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Consent Form

Name*
I am registering as:*
Current Academic Year*
Address*
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Emergency Contact Name*

Insurance Information

Primary Insured
Please list allergies/medical conditions here.
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Over the counter medications**

Release Statement & Signature

Community Expectations & Covenant

 

The mission of the Episcopal Diocese of Maryland Youth & Young Adult Program is to gather, equip, and send young disciples of Jesus Christ to witness to God’s reconciling love. In order to live out our mission statement, all participants agree to actively participate in all parts of the event and to abide by the standards of the community:


 1. I will seek to build up myself, others, and our community in my actions and words, doing my best to ‘love my neighbor as myself.’ (Matthew 22:39)

2. I will respect the person, property, feelings and beliefs of each member of our community.

3. I will respect the property of the host site with the understanding that it is God’s House.

4. When conflicts happen, I will work to resolve them directly with the people involved, as described in Matthew 18:15-17 “If a fellow believer hurts you, go and tell him - work it out between the two of you. If he listens, you’ve made a friend. If he won't listen, take one or two others along so that the presence of witnesses will keep things honest, and try again. If he still won’t listen, tell the church. If he won’t listen to the church, you’ll have to start over from scratch, confront him with the need for repentance, and offer again God’s forgiving love.” (The Message)

5. I will hand in all medication to the event medical coordinator.

6. I will not enter the sleeping areas or restrooms of a gender that I do not identify with.

7. I will wear appropriate clothing that allows me to fully participate. I agree to abide by additional dress-code requirements for special activities.

8. I will follow the event guidelines for cell phone use if I bring one to the event.

9. I will not drive my car during the event, and I will not go to my car without permission from an adult staff member. I will hand my car keys to the event coordinator, knowing they will be returned at the end of the event.

10. I will not engage in sexual activity.

11. I will not bring or use alcohol, tobacco products, marijuana, illegal drugs, fireworks, firearms or any kind of weapon.

12. I will do my best to have fun!


Adults attending the event also agree to abide by these standards and assist with supervision of youth, remembering 2 Timothy 2:24-25, “And the Lord’s servant must not be quarrelsome but kindly to everyone, an apt teacher, patient, correcting opponents with gentleness.”

Participant Acknowledgement of Community Covenant*
Adult/Guardian Acknowledgement of Community Covenant*
Photo/Publicity Release Statement*
Transportation while at the event Release Statement*
Waiver of Liability: I release the Episcopal Diocese of Maryland and its agents, employees, officers, directors and volunteers, from any liability of any kind or nature that may arise in any way from my student’s/my personal participation in this event.
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