Current Grade: If before June 1st, provide the grade your student is in or just graduated from. If on or after June 1st, please provide the grade your student is heading into.
Allergies: (Medication, Food, Insect, Etc) [Ex: Penicillin, Seafood, None (if None)]
Conditions / Special Needs: (Other Medical or Behavioral Conditions)? [Ex: Asthma, ADHD, Autistic, None (if None)]
Current Medications: (List Current Medications) [Ex: Albuterol, Flonase, Ceterizine, None (if None)]
Additional Notes: Is there anything additional that we should know about your child? [Ex: Sensitivity to Strobe Lights, Short Temper, None (if None)]
PARENT/GUARDIAN INFORMATION
EMERGENCY CONTACT INFORMATION
Please provide an emergency contact for your child if we cannot reach you or a second parent/guardian as stated above.
Photo / Video Consent: I authorize the use of video and/or images of the above child/minor for social media posts and/or other visual material of First Church.
Permission Acknowledgement: I give permission for the above child/minor to attend and to be transported to and from First Church gatherings and events.
Release Acknowledgement: It is our great pleasure to serve our community and to have your child/minor participate in our gatherings and events! We do make effort to provide safe and appropriate environments, as well as safe and responsible drivers to provide transportation. That said, we all understand that accidents do happen and unforeseen incidents do occur. Thus, it is our reminder to you that your signature will completely and unconditionally indemnify, hold harmless, and release First Church and its agents, employees, volunteers, and persons from any and all liability cause by negligence of First Church and said persons or behaviors of child/minor for personal injuries, property damage, or wrongful death, in the participation and/or transportation to and/or from First Church and its related events.
Electronic Signature: I consent to the signing of this release form by an electronic signature.
