Youth Ministry

Our youth group (6th-12th grade) is one of the most active ministries in our church! Each week they gather on Sunday morning for Sunday Morning Gatherings (10:00-10:45), on Wednesday Nights after dinner (6:15 p.m.), and for Youth Group on Sunday Evenings (5:30 p.m.). In addition, our youth have mission trips, senior high trips, middle school trips, and other regular outings. If you have specific questions about the Youth Ministry please email our Youth Director, Laura Willoughby at youthdirector@fumcpinemountain.org or text

at (706) 681-2755

Field Trips

1/87

WEDNESDAY NIGHTS
Youth Activities - 6:00-7:30 PM

SUNDAY NIGHTS

Activities 5:30-7:00 pm

Forms and Information
(updated as needed)

Student Leadership Application

Youth Behavior Agreement

Parental Permission and Medical Authorization Form
Please fill out for each one of your youth.
At the end, click Submit.
We will receive your form electronically.
No one else can see the data you enter.

Pine Mountain FUMC Youth

206 McDougald Ave N.

Pine Mountain, GA 31822

706-663-2538

Website: fumcpinemountain.org

Email: office@fumcpinemountain.org

PARENTAL PERMISSION AND

MEDICAL AUTHORIZATION FORM

Participant Name

First and Last name of youth participating

Birth Date

Month

Day

Year

Birthdate of youth participating

Activity Release

I give permission for my child (named above) to attend the events, field trips, and service projects associated with the Youth Group of Pine Mountain FUMC. I further give permission for my child to be transported to and from events by hired and volunteer drivers authorize by the Pine Mountain United Methodist Church.

I further give permission for my child to participate in all activities sponsored by the Youth Group of Pine Mountain FUMC except.

Medical/Custody Release

I hereby authorize the Youth Group leaders, volunteers, Pine Mountain FUMC, hospitals, licensed medical or dental providers, and their agents and employees to have access to the information contained in this form and to provide all medical or dental care, routine tests, treatment, and necessary transportation advisable for the health and safety of my child. This authorization includes the authority to consent to any x-ray examinations, anesthetic, medical procedure or treatment, and hospital care under the supervision,, and upon the advice of or to be rendered by, a physician or surgeon licensed under the Medical Practice Act or dentist licensed under the Dental Practice Act for my child.

I further authorize the Youth Group leaders of Pine Mountain FUMC to receive physical custody of my child upon completion of any treatment, and I specifically instruct any treating health facility to surrender physical custody of my child to said adult.

Signature of Parent or Legal Guardian

Signature of Parent or Legal Guardian acknowledging and agreeing to Activity Release and Medical/Custody Release above

EMERGENCY CONTACT INFORMATION

Emergency Contact Name

First and Last name of Emergency Contact

Emergency Contact Address

Country/Region

Address

Address - line 2

City

Zip / Postal code

Emergency Contact Phone

Phone number for Emergency Contact Listed above

Emergency Contact Email Address

Email address for Emergency Contact listed above

2nd Emergency Contact Name

First/Last Name of 2nd emergency contact

Phone number of 2nd Emergency Contact

Email of 2nd Emergency Contact

Email address of 2nd Emergency Contact

First United Methodist Church
of Pine Mountain

Love God. Love Others.

Youth Ministry

Forms and Information
(updated as needed)

Student Leadership Application

Youth Behavior Agreement

Parental Permission and Medical Authorization Form
Please fill out for each one of your youth.
At the end, click Submit.
We will receive your form electronically.
No one else can see the data you enter.

Pine Mountain FUMC Youth

PARENTAL PERMISSION AND

MEDICAL AUTHORIZATION FORM

SUBSCRIBE FOR EMAILS

Love God. Love Others.

Youth Ministry

Forms and Information (updated as needed)

Student Leadership Application

Youth Behavior Agreement

Parental Permission and Medical Authorization Form Please fill out for each one of your youth. At the end, click Submit. We will receive your form electronically. No one else can see the data you enter.

Pine Mountain FUMC Youth

PARENTAL PERMISSION AND

MEDICAL AUTHORIZATION FORM

SUBSCRIBE FOR EMAILS

Forms and Information
(updated as needed)

Parental Permission and Medical Authorization Form
Please fill out for each one of your youth.
At the end, click Submit.
We will receive your form electronically.
No one else can see the data you enter.