30 Hour Famine 2009

Guidelines and Expectations

Below you will find a list of the rules that are to be followed while participating in the 30
Hour Famine. These are in place to help ensure the safety and well being of each
participant. We ask that you, the parent/legal guardian and your teen sign the bottom of
this slip as a statement that you both understand and plan on adhering to these
expectations.

1) Each youth must follow the guidelines set forth by the leaders at the beginning of
the Famine.
2) Listening to and being respectful of your chaperones is of the utmost importance,
as we will maintain a level of trust and respect with you as well.
3) There will be absolutely NO possession or use of alcohol, tobacco products, or
drugs while participating in this event, or we will be forced to send you home
immediately! We reserve the right to check anyone’s bags for these products and
or for weapons, should suspicion arise.
4) No one is allowed in a sleeping room of the opposite sex at any time!

Because we feel that these rules are important in making the 30 Hour Famine safe and
fun for everyone, the breaking of these will result in consequences. These will range
from a warning, loss of privileges, and possibly being sent home in the worst of
scenarios.

Parent’s Signature: ___________________________Date:_______

Teen’s Signature: ____________________________Date:________

 Permission and Medical Release Form
Baker Memorial United Methodist Youth Group

Name: _________________________________________

Phone #: (______)__________________

Address:_______________________________________

City, State, Zip: __________________________________

Grade: _________________ Age: ___________________

I give my permission for my above named child to participate with the Baker Memorial
United Methodist Youth Group during the 30 Hour Famine 2009, taking place March 27th
and March 28th, 2009 at Baker Memorial UMC. I understand that this event includes
participation in a 30 Hour fast from solid foods. I also understand that fasting for 30
Hours is recommended for children over the age of 12 due to safety concerns. I
understand that my child will also be participating in service projects throughout the
community and may be transported in a chaperone’s vehicle.

I hereby release Baker Memorial United Methodist Church, its staff, sponsors, and
volunteer leaders from responsibility and liability for any injury or illness that my child
may sustain during this activity. In the event of an emergency, I hereby authorize an
adult leader for this activity (J.L. Miller, Heidi Miller, Jeff Thompson, Katie Felton), as
agent for me to consent to any x-ray examination; medical, dental, or surgical diagnosis;
treatment; and hospital care advised and supervised by a physician, surgeon or dentist (as
appropriate) licensed to practice under the laws of the state where the services are
rendered, either at a doctor’s office or at any hospital. I expect to be contacted as soon as
possible.

Signature of parent or legal guardian: ____________________________

Date: ______________

Home Phone #: _________________________

Cell Phone#:____________________________

Emergency Contact, Name and #:___________________________