Encounter Student Trip Consent Form
Child's Full Name
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First Name
Last Name
By checking below you give permission for your child to attend the following activity/activities:
High School Game Show Battle Room and Picnic Trip (07/09/2025)
Junior High Sky Zone and Picnic Trip (07/30/2025)
Bible Study @ the Missouri State Fair (08/12/2025)
Mode of Transportation (If Needed)
I, the parent/guardian of the student named above, by providing my name below hereby give permission for my child to take part in the event(s)/trip(s) I selected above. I understand that the following conditions apply:
a. I understand that I am responsible for getting my child to and from the departure and return sites identified above. I understand that my child shall be accompanied by staff member and volunteers during the trip, including while traveling from the departure site to the destination site, and from the destination site to the return site.
b. I understand that my child is expected to behave responsibly.
c. I agree and understand that I am responsible for the actions of my child, and I release Encounter Church, Encounter Church staff, and Encounter Church volunteers from all claims and liabilities that arise in connection with the trip.
d. I confirm that my child is medically fit and able to participate in all activities for the trip(s) selected, except for the following activities: (please write "Yes" to confirm)
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e. I have indicated below any permanent or temporary medical or other condition(s) including special dietary and medication needs, or the need for visual or auditory aids, which should be known about my child: (please write "N/A" if this does not apply to your child)
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f. I agree that in the event of an emergency injury or illness, the staff member(s) in charge of the trip may act on my behalf and at my expense in obtaining medical treatment for my child.
Printed Name of Parent/Guardian
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First Name
Last Name
Parent/Guardian Phone Number
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Area Code
Phone Number
Parent/Guardian E-mail
Emergency Contact Name:
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First Name
Last Name
Emergency Contact Phone Number
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Area Code
Phone Number
Date
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Month
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Day
Year
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