Parent/Guardian Information

Emergency Contact

Medical Conditions

Please list any other pertinent medical conditions or special needs in as much detail as necessary

Medication Policy

I understand that for my Youth to take or be administered any prescription or non-prescription drugs, over-the-counter medication, herbal supplements, vitamins, etc. I must fill out and sign the Medication Permission form in advance, which can be obtained from the youth leader IN ADDITION TO THIS FORM.

I also understand that youth are not permitted to carry or use any of the aforementioned substances at any 180° Youth event or regular meeting, without having the Medication Permission form on file, and they will be sent home at the parent/guardian's expense if they do.

By clicking "I AGREE," I am confirming that I am either the Youth and over 18, or am the legal parent/guardian of the Youth I am registering, and that I have read, understood, and assent to the above.

Photo Release

I agree that Mt. Zion Baptist Church may photograph and record my Youth’s likeness and activities (Images) via photograph, video or any other format of recording taken during church-related activities. I grant the following rights to Mt. Zion Baptist Church: permission to use and re-use, publish and re-publish, and modify or alter the Image(s) taken during regular meetings and events. Use of the Images for editorial, commercial, trade, advertising, and any other purpose may be done in any medium now existing or subsequently developed, on the church website and on the Internet, and worldwide in perpetuity for the purposes stated above.

I waive my right to inspect or approve any editorial text or copy that is used in connection with the Images and release and discharge Mt. Zion Baptist Church from any and all claims arising out of use of the Images for the purposes described above, including any claims for libel, invasion of privacy, or other tortuous act.

By clicking "I AGREE," I am confirming that I am either the Youth and over 18, or am the legal parent/guardian of the Youth I am registering, and that I have read, understood, and assent to the above.

Modes of Arrival and Departure Release

I hereby give explicit permission to Mt. Zion Baptist Church to allow my Youth to arrive and leave the church building via the selected modes of transport. (Select one or more)

I forever discharge and agree to hold harmless Mt. Zion Baptist Church, its pastors, directors, employees, volunteers and teachers (collectively herein the “Church”) from any and all liability, claims or demands for accidental personal injury, sickness or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by my Child while in transit to or from the premises of the Church. Furthermore, I, on behalf of my Youth, hereby assume all risk of accidental personal injury, sickness, death, damage and expense as a result of my Child taking any of these modes of transport.

By clicking "I AGREE," I am confirming that I am either the Youth and over 18, or am the legal parent/guardian of the Youth I am registering, and that I have read, understood, and assent to the above.

180° Youth Code of Conduct

The following rules and guidelines are equally binding on adult leaders/chaperones and youth while at 180° Youth events and while traveling with 180° Youth: all participants must agree to and abide by the Code of Conduct while at 180° Youth events or traveling with 180° Youth. Any participant who fails to abide by the Code of Conduct may be required to leave immediately at personal (in the case of adult volunteers) or parental/guardian (in the case of youth) expense.

• Participants will make no use of, nor be under the influence of illicit substances including, but not limited to drugs, tobacco, alcohol and any form of vaping.

• Participants will not engage in any form of sexual misconduct, defined as exposure, inappropriate touching, groping, PDA (public or private displays of affection), viewing or taking pornographic photos, seclusion with members of the opposite sex, crude comments or “jokes” made referencing genitalia, parts of the body generally covered by undergarments, or sexual acts.

• Participants will be appropriately and modestly dressed at all times: clothing should not have crude, pornographic or otherwise inappropriate text, images or logos displayed, undergarments should not be visible through or outside clothing, midriffs should be covered, necklines should be conservative, and shorts, pants and skirts should be an appropriate length, fully covering the groin and upper thigh.

• Participants will abide by the laws of the United States and whatever state they currently are in.

• Participants will not possess or interact with fire, fireworks, explosives, incendiary devices, weapons or firearms when not explicitly permitted for an event.

• Participants will refrain from language deemed foul, crude, cruel or inappropriate, including “humor.”

• Participants will not engage in behavior or speech which demeans, bullies, or deprecates other persons.

• Participants will not engage in physical altercations with other persons, even in jest or between siblings.

• Participants will not access their phones outside of times explicitly permitted by adult leaders.

• During events and trips that require over-night stays, participants will stay out of the other gender’s rooms and sleeping areas, visit members of the other gender only in assigned coed community rooms, and will observe lights-out, quiet time and all other provided instructions.

• During events and trips off church property, participants will not go anywhere out of line of sight alone, including public restrooms.

• Participants will be where they are supposed to be, when they are supposed to be there, including adhering to curfews and all other time-based instructions.

• Participants will be alert, present, and pleasant in a way that shows respect for other persons and reverence for God.

Youth Participant’s (or Adult Leader’s) Statement: By clicking "I AGREE," I pledge to honor God and respect others during all activities and regular meetings with 180° Youth by following the Code of Conduct printed above. I understand that I cannot participate in 180° Youth unless this completed form is on file.

Parent/Guardian’s Statement (Required if Youth is under 18): By clicking "I Agree," I agree to support the Code of Conduct above, and will accept full responsibility for the return of my child should he/she break one of these non-negotiable rules.

Final Release

I do hereby give permission for my child (“Participant”), to attend and participate in any Mt Zion Baptist Church youth ministry activities, events, and retreats and during the period of September 1, 2023 – August 31, 2024.

LIABILITY RELEASE: In consideration of Mt Zion Baptist Church allowing the Participant to participate in youth ministry (Sunday worship, Sunday meeting, Activities, Events, Retreats, Lock-Ins, Trips), I, do hereby release, forever discharge and agree to hold harmless Mt Zion Baptist Church, its pastors, directors, employees, volunteers and teachers (collectively herein the “Church”) from any and all liability, claims or demands for accidental personal injury, sickness or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by the undersigned and the Participant while involved in the youth activities. I, the parent or legal guardian of this Participant hereby grant my permission for the Participant to participate fully in youth ministry activities, including trips away from the church premises. Furthermore, I, on behalf of the Participant, hereby assume all risk of accidental personal injury, sickness, death, damage and expense as a result of participation in recreation and work activities involved therein. I hereby agree to hold harmless and indemnify said Church for any liability sustained by said Church as the result of the negligent, willful or intentional acts of said Participant, including expenses incurred attendant thereto.

MEDICAL TREATMENT PERMISSION: I authorize an adult, in whose care the minor has been entrusted, to consent to any emergency x-ray examination, anesthetic, medical, surgical or dental diagnosis or treatment and hospital care, to be rendered to the minor under the general or special supervision and on the advice of any physician or dentist licensed under the provisions of the Medical Practice Act on the medical staff of a licensed hospital or emergency care facility. The undersigned shall be liable and agrees to pay all costs and expenses incurred in connection with such medical and dental services rendered to the youth pursuant to this authorization.

EARLY RETURN HOME POLICY: Should it be necessary for my child or youth to return home due to medical reasons, disciplinary action or otherwise, the undersigned shall assume all transportation costs and responsibility.

TRANSPORTATION PERMISSION: The undersigned does also hereby give permission for my youth to ride in any vehicle driven by an approved and licensed ADULT chaperone while attending and participating in activities sponsored by Mt Zion Baptist Church. My youth and I understand that SEAT BELTS MUST BE WORN AT ALL TIMES during transportation.

By clicking "I AGREE" and submitting the form, I am confirming that I, or I and my Youth (if they are under 18) have read, understood, and assent to the above; have read, understood, and agree to the entire Annual Participation Form, and have accurately and truthfully filled out the forms.