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Parent Consent Form

Parent Consent Form



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Published by yabeeee
Going to Lock-In? You NEED this form! Sign it twice, front and back!
Going to Lock-In? You NEED this form! Sign it twice, front and back!

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Published by: yabeeee on Jun 26, 2008
Copyright:Attribution Non-commercial


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New Hope LeewardEPIC High School Ministry
Parental Consent Special Event Form
Student Information Parent/Guardian Information
 Name:__________________________________ Contact:_______________________ Address:________________________________ Home Phone:___________________ City:___________________ Zip____________ Wk/Cell Phone:_________________ E-Mail:_________________________________ Insurance Company_____________ Phone: _________________________________ Policy #_______________________ Birth Date:________________ Sex:__________ 
 Allergies and Health History
Please list any allergies and any other special medical conditions the student may have: _____________________________________________________________________________ 
I, _________________________(parent or guardian print name) hereby acknowledge that it is my desire (for my child) to participate in
The Overnight Lock In at New Hope Leeward on Friday June 27, 2008
as a church-sponsoredevent of New Hope Leeward, including activities on and/or away from the church premises as well as transportation to and fromsuch activities. MY CHILD IS VOLUNTARILY PARTICIPATING IN THESE ACTIVITIES, INCLUDINGTRANSPORTATION TO AND FROM SUCH ACTIVITIES, WITH KNOWLEDGE OF THE DANGERS INVOLVED ANDHEREBY AGREE TO ACCEPT ANY AND ALL RISK OF INJURY AS A RESULT OF SUCH PARTICIPATION ANDTRANSPORTATION.As lawful consideration for permitting me (my child) to participate in such activities, including the transportation to and fromsuch activities, I hereby release and discharge New Hope Leeward, its officers, employees, agents and members of the Board of Elders from all actions, claims or demands I and my heirs, distributes, guardians, legal representatives or assigns now have or may hereafter have for any injury or damages resulting from the negligence or other acts, howsoever caused, by such church,officers, employees, agents and Board of Elders, before or during my participation in such church sponsored activities on and/or away from the church premises, including transportation to and from such activities. I HAVE CARFULLY READ THISAGREEMENT AND UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY ANDAN ASSUMPTION OF RISKS AND SIGN IT OF MY OWN FREE WILL. ________________________________________________________________________________________________________ 
Parent/Guardian Signature Date Student Signature Date
A signed parental consent & policy form, located on the back side is required to attend. There is a $5.00admission fee that includes provision of food for the night. You will be required to stay from 11:00-7:00 amunless special arrangements are cleared with your parents. Please note, this event will be video taped for futureyouth promotion videos to be shown in the main church service. By signing, you are permitting pictures or footage of your child to be used. For questions regarding this event please contact Brandon at 561-3222.

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