Liability Release Form
I/We understand that there are inherent risks involved in any youth trip, and I/we hereby release Springfield First Church of God, its agents, and volunteer youth leaders from any and all liability for any injury, loss, or damage, to person or property that may occur during the course of my/our involvement in youth activities from January 1, 2009 through December 31, 2009.
Participant:
Print Name Signature Date of Birth
Date: _______________________
Parent/Guardian(s):
Print Name Signature Relationship
Print Name Signature Relationship
Date: _______________________
Agreement to Transport Home
I/We, the undersigned, are the parents, the parents having legal custody, or the legal guardians of __________________________, a minor, and have given our consent for him/her to attend sponsored youth events of the Springfield First Church of God taking place from January 1, 2009 through December 31, 2009.
I/We understand that group leaders(s) may need to send a student home as a result of illness or discipline problems. I/We understand that if the student named above is dismissed from the trip he/she will be transported home at my/our expense. Springfield First Church of God Youth Leaders will attempt to contact the parent/guardian to arrange such transportation if necessary.
Parent/Guardian(s):
Print Name Signature Relationship
Print Name Signature Relationship
Date: _______________________
Primary Phone Number:_____________________________
Secondary Phone Number:___________________________
Tertiary (3rd) Phone Number:_________________________
Medical Emergency Authorization Form
NAME:_______________________________ Date of Birth:___/___/_____
Parent/Guardian Name:__________________________________________
Address:______________________________________________________
Home Phone #:_________________ Work Phone #:___________________
Other Phone # (Pager, Cell, or Emergency Number):___________________
Medical Release
In the event of an emergency where medical treatment is required, and reasonable attempts to contact me at the above listed numbers has been unsuccessful, I hereby give my permission and authorization to Bruce Shanks or an approved youth counselor from Springfield First Church of God to obtain the necessary medical treatment for _______________________.
______________________ ______________
Signature of Parent or Legal Guardian Date
Medical Information
Family Physician:___________________________________ Phone #:________________________
Medications:_______________________________________________________________________
Allergies or Medical Concerns:________________________________________________________
_________________________________________________________________________________
Insurance Company:____________________________________ ID #:________________________
Liability Release Form
I/We understand that there are inherent risks involved in any youth trip, and I/we hereby release Springfield First Church of God, its agents, and volunteer youth leaders from any and all liability for any injury, loss, or damage, to person or property that may occur during the course of my/our involvement in youth activities from January 1, 2009 through December 31, 2009.
Participant:
Print Name Signature Date of Birth
Date: _______________________
Parent/Guardian(s):
Print Name Signature Relationship
Print Name Signature Relationship
Date: _______________________
Agreement to Transport Home
I/We, the undersigned, are the parents, the parents having legal custody, or the legal guardians of __________________________, a minor, and have given our consent for him/her to attend sponsored youth events of the Springfield First Church of God taking place from January 1, 2009 through December 31, 2009.
I/We understand that group leaders(s) may need to send a student home as a result of illness or discipline problems. I/We understand that if the student named above is dismissed from the trip he/she will be transported home at my/our expense. Springfield First Church of God Youth Leaders will attempt to contact the parent/guardian to arrange such transportation if necessary.
Parent/Guardian(s):
Print Name Signature Relationship
Print Name Signature Relationship
Date: _______________________
Primary Phone Number:_____________________________
Secondary Phone Number:___________________________
Tertiary (3rd) Phone Number:_________________________
Medical Emergency Authorization Form
NAME:_______________________________ Date of Birth:___/___/_____
Parent/Guardian Name:__________________________________________
Address:______________________________________________________
Home Phone #:_________________ Work Phone #:___________________
Other Phone # (Pager, Cell, or Emergency Number):___________________
Medical Release
In the event of an emergency where medical treatment is required, and reasonable attempts to contact me at the above listed numbers has been unsuccessful, I hereby give my permission and authorization to Bruce Shanks or an approved youth counselor from Springfield First Church of God to obtain the necessary medical treatment for _______________________.
______________________ ______________
Signature of Parent or Legal Guardian Date
Medical Information
Family Physician:___________________________________ Phone #:________________________
Medications:_______________________________________________________________________
Allergies or Medical Concerns:________________________________________________________
_________________________________________________________________________________
Insurance Company:____________________________________ ID #:________________________