YOUTH EVENT PERMISSION FORM

KNOBELES DAY OCTOBER 25 @ 1 P.M.

Parents / Guardians
Please make sure to fill out all information.

You may sign up 3 youth on this form at a time.
At the end of the form, sign your name and choose submit.

You will receive a Thank You confirmation.

#1 Student's Name:

First Name

Last Name

Grade

#2 Student's Name:

First Name

Last Name

Grade

#3 Student's Name:

First Name

Last Name

Grade

PARENT(S) / GUARDIAN(S) NAME

First Name

Last Name

Phone #(s) to contact in case of emergency:

(###)

###

####

Phone #(s) to contact in case of emergency:

(###)

###

####

In Case of Medical Emergency

By completing this registration card, I give New Harvest permission to send my teen(s) to the nearest medical facility in the event of an emergency if I cannot be reached

Yes, I give permission

Photography / Video

My permission for my child/and or family to be included in images that may be shared with the public, included in but not limited to: shown at church or online (ie. website and social media).

Yes, I give permission

No, I do not give permission

CONSENT & AFFIRMATION OF LIABILITY

I understand that in no event will New Harvest Community Church and their ministries, or volunteers be held responsible for loss of property, nor injury or death due to an accident. I do hereby give my permission to the staff/volunteers of New Harvest Community Church to obtain and administer such medical aid or assistance as might be required for the immediate care of my teen in the event such help of any emergency nature becomes necessary. I am responsible for payment of any medical charges/expenses not covered by my insurance or the insurance applicable to my child (if any). Responsibility: I hereby assume all responsibility for his/her conduct, and for any damage my teen does to the property of New Harvest Community Church or any other property with the understanding that I will pay all damages. Use or Possession Of: alcohol, illegal drugs, any sexual conduct that is illegal, a failure to refrain from inappropriate touching, and any form of verbal and physical harassment is not tolerated. Cigarette Smoking and smokeless tobacco is forbidden. If the teen is caught with it, we will take it. My name below indicates that ALL information provided on this form is true and accurate, and that I fully agree to all statements made on the form, including but not limited to the Authorization and Release of Liability and Consent to Medical Treatment.