GOD IS GOOD MINISTRIES OF DALLAS - CHILD RELEASE FORM - JESUS CAMP
This is my authorization to allow a designated person to drop off or pick up my child. I am the parent and/or guardian of the child listed below. Also, I signed my child's application and filled out the medical history accurately.
CAMPER NAME
First Name
Last Name
If more than one child, please list out all of the children:
PERSON DROPPING OFF CHILD
First Name
Last Name
PERSON PICKING UP CHILD
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Parent or guardian drivers license or government issued ID:
*
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I understand that my signature on this form constitutes a legal digital signature approving application. I understand that I must be a parent or legal guardian if I'm signing for a child under the age of 18. I have read this application and approve. By signing below, I hereby agree to the "ASSUMPTION OF RISK AND RELEASE OF LIABILITY AGREEMENT, AUTHORIZATION FOR MEDICAL TREATMENT OF A MINOR AGREEMENT, MEDICATION AUTHORIZATION AND RELEASE AGREEMENT" including all statements listed on this application. Please add anymore information in the text box below:
Signature
NAME OF PARENT OR GUARDIAN.
First Name
Last Name
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