Student Information

Parental or Guardian Information

Secondary Emergency Contact Information

Student's Medical Information

Safety & Identity Protection

Student Interests Profile

Emergency Authorization - I/We the undersigned have legal custody of the student named above, a minor, and have given our consent for him/her to attend events being organized by the Church. I/We understand that there are inherent risks involved in any ministry or athletic event, and I/we hereby release the Church, its pastors, employees, agents, and volunteer workers from any and all liability for any injury, loss, or damage to person or property that may occur during the course of my/our child’s involvement. If he/she is injured and requires the attention of a doctor, I/we consent to any reasonable medical treatment as deemed necessary by a licensed physician. In the event, treatment becomes required from a doctor or hospital personnel designated by the Church, I/we agree to hold such person free and harmless from any claims, demands, or suits for damages arising from the giving of such consent. I/We also acknowledge that we will be ultimately responsible for the cost of any medical care should the cost of that medical care not be reimbursed by the health insurance provider. Further, I/we affirm that the health insurance information provided above is accurate at this date and will, to the best of my/our knowledge, still be in force for the student named above. I/we also agree to bring my/our child home at my/our own expense should they become ill or if deemed necessary by the student ministries staff member. I/We allow any youth leader to give any medical treatment deemed necessary (including giving ibuprofen, Pepto-Bismol, etc.).