Annual Session 2017
Medical Form

Please complete all of the sections required below and click the Submit button. Your information will be sent to the appropriate members of the Program Committee, and you will receive an email copy of your information, Please print this out, endorse the bottom of the note, and either mail the signed information and a copy of a current insurance card to the BYM office by no later than Monday, July 24, or bring them with you to Frederick.

Please remember that no youth may be permitted to participate in any youth activities, including Young Friends, until the signed document has been received. Children must remain with their parents until that time.

Young Friends who attended a Young Friends or Junior Young Friends Conference in the 2016-2017 academic year do not need to complete a new form.

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Release and Agreement for Annual Session Programs

In consideration of being allowed to participate in the Annual Session youth programs of Baltimore Yearly Meeting, its related events and activities, I, the undersigned, acknowledge, appreciate, and agree that:

I knowingly and freely assume all such risks, both known and unknown, even if arising from the negligence of the releasees or other, and assume full responsibility for my participation.
I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, whereby release, indemnify, and hold harmless the Baltimore Yearly Meeting of the Religious Society of Friends, Inc. their officers, officials, agents and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and, if applicable, owners and lessors of premises used for the activity, with respect to any and all injury, disability, death, or loss or damage to person or property associated with my presence or participation, whether arising from the negligence of the releasees or otherwise, to the fullest extent permitted by law.
I understand and agree that photographs of myself/my child may be printed in promotional materials. I further understand and agree that my/my child’s likeness, in photographs or videos, may appear on a webpage or webpages produced by Baltimore Yearly Meeting and that such webpage(s) will be accessible via the Internet. I agree that any materials produced pursuant to this release may be used, in whole or in part, without inspection or further consent or approval by me, of the finished product or any use of said materials or product by BYM.
Name of Participant and current age
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Enter "N/A" if over 18
Name of Parent/Guardian
I hereby give permission for my child named above to attend Annual Session youth activities. I give the Baltimore Yearly Meeting staff and its volunteers permission to obtain emergency medical attention as needed, and will be responsible for costs incurred for any medical treatment. In the event that my child needs medication and it unable to administer it, I give permission for a staff member or volunteer to do so. I hereby release Baltimore Yearly Meeting, its staff, and its volunteers from liability for any injury or illness my child may sustain during such an event. If my child is taking presecribed medications, I understand that it is their responsibility to take the correct dosage at the correct time. Failure to do so will result in their being asked to leave the conference immediately and I will be responsible for arranging their immediate pickup.
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