Pelham Students Event Permission Form

Pelham Students Event Permission Form

A form will need to be filled out for each student seperately
What: Youth Rally

When: Sunday, February 23rd | 6pm

Where: Church at the Brook, Millbrook, AL

Transportation: Carpool from Pelham Church

*ALL STUDENTS MUST HAVE A PARENT'S PERMISSION**

STUDENT INFORMATION

EACH STUDENT WILL NEED TO BE REGISTERED INDIVIDUALLY.
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Phone*
Please enter a valid phone number.
Would you like to add another parent/guardian contact?

YesNo
Parent/Guardian 2 Name

First NameLast Name
Parent/Guardian Phone 2
Please enter a valid phone number.
Would you like to add any additonal emergency contacts for your student?

YesNo
Emergency Contacts Information
Student's Name*

First NameLast Name
Student's Birthday*

MonthDayYear
Date
Photo Release:

Please note that photos of Pelham Students are taken throughout the year at our various events and activities. These photographs are used to highlight Pelham Students on social media and other diverse communication formats.
Please check the back to verify that you have read the above Photo Release statement.*

I have read the Photo Release statement.
Liability Release Statement

Please read each statement and initial after each one.
I give permission to my son/daugter to participate in the trip to the Youth Rally held at Church at the Brook in Millbrook, AL on February 23, 2025 and all events therein. (initial)*
I further authorize that Pelham Students Ministry Leaders and Team to seek and arrange medical care, hospitalization, or surgery that may become necessary in my absence and I will assume all financial responsibility for the same. (initial)*
I, being 18 years of age or older, do for myself (and for and on behalf of my child-participant if said child is not 18 years of age or older) do hereby release, forever discharge and agree to hold harmless Church of God International Offices and the directors thereof along with the Alabama Church of God Executive Offices, along with Pelham Church of God, from any and all liability, claims or demands for personal injury, sickness or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by the undersigned (or said child-participant) while participating in the trip or activity.Furthermore, I assume all risk of personal injury, sickness, death, damage and expense as a result of my or my child's participation in all activities involved therein. (initial) *
By signing below you agree to the the liability release statement and that all the information entered on this Pelham Students Event Permission Form is accurate and complete to the best of your knowledge.*

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Pelham Students Event Permission Form

STUDENT INFORMATION