Youth Forms

For some of our events, youth and parents need to fill out forms to participate. These forms need to be updated each year. Please fill out the form below for the year 2021. Thank you!

3-in-1 Online Form

Youth Ministry - Medical, Liability, and Media Consent

  • Date Format: MM slash DD slash YYYY
  • I hereby give permission for the above-named youth (herein “Youth”) to participate in the above- named event and its related activities, including without limitation transportation to and from such activities, if applicable (herein “Event”) as organized by First Presbyterian Church in Harrisonburg, VA (herein “FPC”). I hereby release, hold harmless and absolve FPC, its officers, trustees, employees, staff, sponsors, vendors, volunteers, and all others who have participated in the planning, organizing and implementing of the Event, be they individuals or organizations, singly or collectively, from responsibility with respect to Youth's participation in the Event. If the Youth is a minor, in the event of a medical emergency in which the Emergency Contact Person named above cannot be reached after reasonable effort has been made to secure personal consent, I authorize any and all treatment of the Youth which is medically necessary in the opinion of the attending physician. If the Youth has any medical conditions or is taking any medications which may be relevant to a physician in the event of a medical emergency, I have listed them above. I hereby release and discharge FPC and all affiliated entities from any and all claims, demands, or causes of action that I have in connection with the use and exercise of the rights granted in this release.
    Please select one.
  • FPC may tape or photograph Youth and record his/her voice during his/her participation in the Event and that FPC may use any such recordings or photographs, in whole or in part, whether in original or modified form, in any manner or media, for the purpose of advertising, promoting, and publicizing FPC whether during the Event or thereafter.
  • Your name here serves as your signature.
  • This field is for validation purposes and should be left unchanged.