Parental Consent Form


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Parental Consent Form (for participants age 17 and younger) Statement of Activities and Release of Liability Form I/we, ____________________________________________________________ (print parent’s/guardian’s name(s)), the parent(s)/ guardian(s) of ___________________________________________ (print child’s name), give my/our child, a minor of __________________________________________________________ (print address) permission to accompany a youth mission team to the Rio Grande Valley of Texas, Mission Service Project (also known as MSP) and participate as a member of the group. I/We acknowledge that we are allowing our child to participate entirely upon our own initiative, risk and responsibility. I/We acknowledge and agree in participating in MSP the nature of the service to be performed includes but are not limited to physical labor, yardwork, gardening, construction activities including, but not limited to building repairs, demolition, carpentry, digging, painting, flooring, masonry, sheet rocking, exposure to hazardous material, and other facets of construction. These activities may include, but are not limited to the use of power tools such as drills, as well as the use of hand tools, and other construction tools such as ladders, scaffolding, lawn mowers, gardening equipment and tools. The activities may also require climbing with and without supplies, tools and materials as well as working on ladders and other facets of construction work. Participants will also be involved in food preparation and service. I/We acknowledge that the risks of participation in MSP also include, but are not limited to, the risks of travel, the risks of negligence, gross negligence, willful and wanton misconduct and/or bad judgement by him/her or other participants, including the clients, coordinators, volunteers, and site inspectors; contact with unidentified and unfamiliar persons, and the risks of failure, misuse and malfunctioning of equipment; I/We understand in their free time, volunteers may choose to engage in activities including, but not limited to sports, hiking, shopping, touring or other activities of their choosing. MSP may sponsor some recreational activities, which may include, but are not limited to swimming, basketball, volleyball, baseball, football and Frisbee. Other activities include, but are not limited to, travel to homes, parks, theaters, churches, restaurants and shops. I/We hereby represent that my/our child is in good physical condition and health, is capable of safely performing the activities for which he/she has volunteered and does not pose a risk of harm to himself/herself or other participants. I/We assume, to the greatest extent permitted by law, all of the risks to my/our child, whether or not specifically identified herein, or all the activities in which her/she participates and the services he/she uses and/or provides. Volunteers are not required to engage in any activity which they feel they are not able to safely participate. Photo Release: By signing below, I authorize publication, broadcast or other use of my child/youth’s name, photograph, likeness, image, voice and biography in any and all media, publications, advertising, and publicity arising out of any activity associated with the MSP without further compensation and agree that all such materials are the sole property of MSP. Now therefore, in consideration of the permission extended to our child/youth to accompany the mission team and participate in the mission trip, I/we do hereby for myself/ourselves, my/our child, my/our heirs, executors and administrators, remise, release, and forever discharge the team leader(s)______________________(print), the United Methodist Church, Rio Texas Conference of the UMC, employees, trustees, volunteers, coordinators, participants, equipment providers, Mission Service Project (MSP), its sponsors and MSP clients acting officially or otherwise, from all claims, demands, actions or causes of action of any kind including the death of my/our child or any injury to my/our child or loss or damage to property which may occur from any case during the trip as well as all ground travel incident of such trip. It is my/our intention of this document to consent to my/our child’s participation in Mission Service Project (MSP), to consent to allow the team leader(s) ________________________(print), to act in loco parentis (“in the place of a parent”) for the duration of the mission trip; and to waive and forego all right of action of myself/ourselves and my/our child against the parties herein before named. __________________________________________________ Parent/Guardian - Signature Date

____________________________________________________ Parent/Guardian - Printed Name

__________________________________________________ Address

____________________________________________________ Relation to child

Witness (third party, adult) Signature_____________________________________________Date____________________________

Statement of Activities and Release of Liability Form ADULTS (only) 

I, _________________________________________(print name) wish to volunteer my services with Mission Service Project (also known as MSP). I acknowledge and agree in participating in MSP the nature of the service to be performed includes but are not limited to physical labor, yardwork, gardening, construction activities including, but not limited to building repairs, demolition, carpentry, digging, painting, flooring, masonry, sheet rocking, exposure to hazardous material, and other facets of construction. These activities may include, but are not limited to the use of power tools such as drills, as well as the use of hand tools, and other construction tools such as ladders, scaffolding, lawn mowers, gardening equipment and tools. The activities may also require climbing with and without supplies, tools and materials as well as working on ladders and other facets of construction work. Participants will also be involved in food preparation and service.



I acknowledge that the risks of participation in MSP also include, but are not limited to, the risks of travel, the risks of negligence, gross negligence, willful and wanton misconduct and/or bad judgement by me or other participants, including the clients, coordinators, volunteers, and site inspectors; contact with unidentified and unfamiliar persons, and the risks of failure, misuse and malfunctioning of equipment;



I understand in their free time, volunteers may choose to engage in activities including, but not limited to sports, hiking, shopping, touring or other activities of their choosing. MSP may sponsor some recreational activities, which may include, but are not limited to swimming, basketball, volleyball, baseball, football and Frisbee. Other activities include, but are not limited to, travel to homes, parks, theaters, churches, restaurants and shops.



I hereby represent that I am in good physical condition and health, am capable of safely performing the activities for which I have volunteered and do not pose a risk of harm to myself or other participants.



I assume, to the greatest extent permitted by law, all of the risks to me, whether or not specifically identified herein, or all the activities in which I participate and the services I use and/or provide.



Volunteers are not required to engage in any activity which they feel they are not able to safely participate.



Photo Release: By signing below, I authorize publication, broadcast or other use of my name, photograph, likeness, image, voice and biography in in any and all media, publications, advertising, and publicity arising out of any activity associated with the MSP without further compensation and agree that all such materials are the sole property of MSP.



On behalf of myself and my heirs, I indemnify and hold harmless Mission Service Project (MSP), its sponsors, the United Methodist Church, Rio Texas Conference of the UMC, employees, trustees, volunteers, coordinators, participants, equipment providers, MSP clients acting officially or otherwise, from any and all costs, liabilities and claims, of every kind and nature whatsoever, arising directly or indirectly, from my participation in activities or use of services, including any legal costs and expenses and the costs of medical or other expenses incurred for my benefit.



I have listed on the Medical Release form, any and all special medical problems concerning myself, and confirm that I have advised the leaders of Mission Service Project (MSP) of any special medical problems. _________________________________________ Participant’s Name (print)

__________________________________________ Participant’s (signature)

_________________________________________ Date _________________________________________ Witness - Signature

__________________________________________ Date