Youth Conference Permission Slip

Each participant (including leaders) completes this form separately for each event or activity involving an overnight stay, travel outside the local area, or higher than

ordinary risks (see General Handbook: Serving in The Church of Jesus Christ of Latter-day Saints, 20.5.5, 20.7.4, 20.7.7). The event or activity leader should have access to all

participants’ forms during the activity.

Event Details (to be filled out by event planner)

Event Date(s) of event

Describe event and activities (please be specific)

Ward Stake

Event or activity leader Event or activity leader’s phone number Event or activity leader’s email

Contact Information

Participant Date of birth Age

Telephone number

Address City State or province

Emergency contact (parent or guardian) Primary telephone number Secondary telephone number

Medical Information

Does the participant require a special diet?

□ Yes □ No

If yes, please explain the dietary restrictions.

Does the participant have any allergies?

□ Yes □ No

If yes, please list the allergies.

List all prescription or over-the-counter (OTC) medications the participant is taking. Leave blank if none.

Can the participant self-administer his or her medication?

□ Yes □ No If no, please contact the event or activity leader directly.

Conditions That Limit Activity

Does the participant have a chronic or recurring illness?

□ Yes □ No

If yes, please explain.

Has the participant had surgery or a serious illness in the past year?

□ Yes □ No

If yes, please explain.

Identify any other limits, restrictions, or disabilities that could prevent the participant from fully participating in the event or activity.

Other Accommodations or Special Needs

Identify any other needs or considerations the participant has that the event or activity planner should be aware of (attach additional pages if needed).

Permission

I give permission for my child or youth (or if signing on my own behalf, as a leader

attending this activity, I personally consent) to participate in the event and activities

listed above (unless noted) and authorize the adult leaders supervising this event to

administer emergency treatment to the above-named participant for any accident or

illness and to act in my stead in approving necessary medical care. This authorization

shall cover this event and travel to and from this event.

Please note: Units may not have the ability to meet all medical, physical, and

other accommodations and are asked to counsel with parents or guardians on

what is possible.

The participant is responsible for his or her own conduct and is aware of and

agrees to abide by Church standards, camp or event safety rules, and other

pertinent instructions. The participant’s conduct and interactions should abide by

Church standards and exemplify Christlike behavior, including those listed on the

attached “Conduct at Church Activities.”

Parents and participants should understand that participation in an activity is not

a right but a privilege that can be revoked if participants behave inappropriately or

if they pose a risk to themselves or others.

This information is collected to help event and activity leaders or medical

personnel so they can be prepared and appropriately respond to health concerns

or an emergency. It will be kept confidential and shared only as needed.

Participant’s signature Date

Parent or guardian’s signature (if participant is a minor) Date

Conduct at Church Activities

Permission and Medical Release Form

(Ward Leader information)

(If more space is needed, please email Sis. Padgett at [email protected])

2026 Naples Stake Youth Conference

Tuesday June 2nd - Friday June 5th

Youth Conference will be held at Camp Geneva in Fruitland Park, Florida

Mandi Padgett 239-431-1228 [email protected]