Towson

  United Methodist Church

    501 Hampton Lane

    (Beltway Exit 27B & Dulaney Valley Road)                                  email: towsonumc@towsonumc.org

    Towson, Maryland 21286             410-823-6511                         Elevator is available to access all 3 floors!

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APPENDIX K

POLICY OF THE TOWSON UNITED METHODIST CHURCH FOR THE PREVENTION OF ABUSE OF CHILDREN AND YOUTH

WAIVER FORM

Ministry/Ministry Event:_______________________________________________________________________

Requested Policy Waiver:_____________________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

Reasons for Requested Waiver: _______________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

Duration of Waiver:__________________________________________________________________________

Parental Consent Required? (see Policy Section 8.0)    ☐ Yes     ☐ No

THE UNDERSIGNED HEREBY ACKNOWLEDGE AND CONSENT TO THE FOREGOING WAIVER(S) OF THE POLICY OF THE TOWSON UNITED METHODIST CHURCH FOR THE PREVENTION OF ABUSE OF CHILDREN AND YOUTH.  SUCH WAIVER(S) IS/ARE BEING PROVIDED ONLY WITH RESPECT TO THE SPECIFIC MINISTRIES AND/OR EVENTS DESCRIBED ABOVE.  ANY REQUIRED PARENTAL CONSENT TO THE FOREGOING WAIVER(S) MAY BE REVOKED AT ANY TIME PRIOR TO THE COMMENCEMENT OF THE DESCRIBED MINISTRY EVENT DESCRIBED ABOVE BY COMMUNICATING SUCH REVOCATION IN WRITING TO _____________________________________________________________________.

____________________________________________________________________________________________ 

Parent signature (if consent is required)                                                              Senior Clergy signature

____________________________________________________________________________________________

Printed name of Parent                                                                            Printed name of Senior Clergy

_________________________________________

Parent signature (if consent is required)

_________________________________________

Printed name of Parent