Youth Permission Form

I, the undersigned parent or legal guardian of the listed minor, authorize the Kilmarnock United
Methodist Church (KUMC) designated youth volunteers to transport the minor to and from KUMC related events.

In the event of an emergency, I give permission to the designated youth volunteers to seek appropriate medical attention for my youth. This authority is granted only after a reasonable attempt has been made to contact me. I understand that while the Kilmarnock United Methodist Church staff and designated youth volunteers will make every effort to insure my child’s safety, they cannot take responsibility for any injuries to my child that are reasonably beyond their control. I hereby waive, release, and forever discharge all rights and claims for damages arising from personal injuries to my youth that I may have against the United Methodist Church, Kilmarnock UMC, or any representative or volunteer.

By completing this form, I give Kilmarnock United Methodist Church permission to share my child’s photograph through church communications, social media, and the Rappahannock Record.

I give permission for my child, the listed minor, to visit shut-ins at Rappahannock Westminster-Canterbury and Commonwealth Assisted Living on Sunday, September 8, 2024.

Please add the following designated youth volunteers’ cell numbers to your contacts for easy communication:

Whitney Lang 804-577-7637
Tammy Crandall 804-761-2990