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Wright View Church of the Nazarene

Youth Activity Permission Slip & Covenant

(please complete all pages) Youth Information First & Last Name: ____________________ Birth Date: __________ Grade: ___ Home # ___________Cell # ______________ E-mail: _________________________ Street Address: ______________________________________ Zip code _______ Do you have a Facebook? _____ Texting? _____ Parent/Guardian Information Mother's Name: ______________________ E-mail: _______________________

Home # _____________ Mother's Work # _____________ Cell # ____________ Father's Name: _______________________ E-mail: _______________________

Home #: _____________ Father's Work # _____________ Cell # ____________ Emergency Information Emergency Contact Person (other than parent):_____________________________ Home Phone: _____________________ Alternate Phone:____________________ Name and phone # of physician in emergency:______________________________ Health concerns (allergies, medications, etc.):_______________________________ ____________________________________________________________________ This permission form is valid during the 2012-2013 year for the following: (please check all that may apply) __ Sunday Evening Activity __ Wednesday Evening Activity __ Youth Monthly Trips/Activity __Fundraisers
* Youth Camp will require additional forms. As parent or guardian I give permission for my child to participate in the above-described youth group activities associated with Wright View Church of the Nazarene. I understand that these events will be chaperoned by adult volunteers and/or a church staff member. In the event that I cannot be reached in an emergency, I hereby give my permission to the physician or medical facility selected by my childs advisor and/or group leader to secure proper treatment for my child as named above. I hereby give permission to display photographs/video taken of my child during youth events: YES ___ NO___ (only first names will be used) Parent Signature: ___________________________________ Date: ___________

__ Sunday Morning Activity __ SWO District Events __ Local Community/Service Projects __ Vacation Bible School

Wright View Church of the Nazarene 2012 Youth Activity Permission Form

Youth Covenant
* Your participation in youth activities carries the responsibility of representing all Wright View Church of the Nazarene Youth. You are expected to conduct yourself in a manner that reflects well on your peers as well as yourself. Your contributions to the activities are as important as what you receive from them. IN ORDER TO PARTICIPATE IN THIS CHRISTIAN COMMUNITY I, __________________, COMMIT MYSELF TO THE FOLLOWING GUIDELINES: 1. I will behave in a manner consistent with our Christian faith, refraining from foul language, disruptive behavior and excessive rowdiness (i.e. no name calling, hitting or other rough play will be tolerated). I will treat all peers and adult participants with respect and kindness. I promise to abide by the event schedule and to remain in designated areas, unless permission of sponsors is obtained first. I will be prepared for the various types of activities or events. Examples: Completed permission forms, bring the required amount of money, wear or bring the appropriate form of attire (weather appropriate and church appropriate clothing) and so on. I will respect the property of the church, event sites and other participants. Should damage occur, myself and/or my parents will be responsible for cost of replacement. I understand that it is the church policy that no youth may drive to or from a churchsponsored youth activity if organized transportation is being provided. I understand that all events are tobacco, drug, and alcohol-free and I will not bring or use any of these substances at any church-related activities or events. I agree that displays of personal affection (kissing, etc) are inappropriate and will not be tolerated.







IN THE EVENT THAT THE ABOVE EXPECTATIONS ARE NOT MET: 1. 2. 3. I will have the opportunity to explain my actions to sponsors in charge. Disruptive behavior will be documented and discussed with my parents and the Pastors I understand that continued disruptions, and/or failure to conduct myself in a way that is in agreement with this covenant may result in expulsion from the activity. My parent/guardian will be contacted, and will be responsible for making arrangements (at parental expense) for me to be picked-up and transported home immediately. Youth not observing #6 and #7 above will result in the individual being removed from the group setting and being sent home at the earliest possible time.


Youth Signature: __________________________________ Date: ___________ Parent Signature: __________________________________ Date: ___________

Wright View Church of the Nazarene 2012 Youth Activity Permission Form