Appendix C

PARENTAL PERMISSION FOR YOUTH VOLUNTEERS

Name of Youth Volunteer:
Name of Camp/Program and location:
The undersigned represents that s/he is the custodial parent/legal guardian of the above identified participant. The volunteer has my/our permission to assist with the ministry of : Name of Church:
During the following time period:	to
This permission is given by me/us with full knowledge of the conditions and activities with which s/he will be assisting, including but not limited to, work with children and other youth. The youth volunteer has no physical or mental disabilities that would impair their participation except as noted here:
I/We will not hold the above named church, its employees or volunteers liable for injuries suffered during the course of the volunteer activities and will hold the church harmless from any financial loss as a result of injury to and/or claim by the volunteer.
I/We give permission for pictures taken to be used for the church’s promotional purposes.
Readable Signature of Custodial Parent/Legal Guardian		Date
Readable Signature of Custodial Parent/Legal Guardian		Date