2018 JH Mission Trip Emergency Consent Form for Overnight Events

This form is to be completed by all students attending an overnight trip with Avon Lake U.C.C. and Waypoint Youth Ministries.
Please list any prescribed or over-the-counter medications your child is currently taking. All medication, excluding inhalers, contraceptives, epi-pens and topical creams, must be taken while administered by a member of our Mission Trip Adult Leadership Team.
Parent/Guardian Self-Carry Authorization

Medication Procedures

1. All medications must include the original Rx or OTC bottle with complete directions. If a weekly pill reminder box is utilized, it must have the student’s name on it, and the original pill bottles must still be sent with it. All Medication, prescription & over the counter must be kept locked up with the designated Medication Person attending the trip. Please pack only the amount of medication needed for the trip. Put all Rx and OTC medications for each individual in a large clear Ziploc labeled with the student’s name.

2. If the student carries medicine without meeting the above criteria, the medication will be taken from the student and the student will be subject to disciplinary actions and possibly removal from the trip, sent home at the parent’s expense.

3. The chaperones on this trip have permission to take my child to a hospital or medical facility for emergency medical or dental treatment.

CONSENT:
I hereby agree to hold the Avon Lake United Church of Christ, the Director of Youth Ministries, Adult Volunteers, staff and any other chaperones harmless for any accident that may occur during the trip.
Over The Counter Medications

Insurance Information

Please upload the front and back of your insurance card or scan and email a copy and send it to nate@avonlakeucc.org

Description

This form is to be completed by all students attending an overnight trip with Avon Lake U.C.C. and Waypoint Youth Ministries.