ValleyFair Parental Authorization and Consent- Liability Release Statement
  • Valley Fair Parental Authorization and Consent- Liability Release Statement

  • Activity Information

    I understand that by signing this form I am giving permission for the listed student to participate in all activities. Every activity is carefully planned and adequately supervised by mature adults. However, even with the best of planning and precaution, unseen events occur. By signing this form, the parent or guardian agrees to assume all risks and hazards inherent in activities. They also agree to not hold Harvest Outreach Church Assemblies of God, its' employees or volunteer assistants, liable for damage, losses and injuries to the person or property undersigned.
  • Name of Event: Valley Fair

    Locaton: 1 Valley Fair Dr, Shakopee, MN 55379

    Dates and Times: August 7th, 2025 Van leaves @ 8 AM. Van leaves ValleyFair @ 5 PM, stop for dinner on the way home. Return by approximately 9 PM.

    Transportation: Van owned by Harvest Outreach Church

    Cost: $40 for admission and travel, plus money for two meals and snacks. Payment of $40 for admission must be made to HOC by Sunday, August 3.

    Sign Up Deadline: Sunday, August 3

    Other: Bring anything needed for the waterpark if you choose. (Does not cost any extra for entry.)

  • Pictures and Video

    We authorize Harvest Outreach Church to use our child or youth's likeness in photographs or video in any and all of its publications and other media. We will make no monetary claim or other claim against the church for the use of such photos or videos.
  • Discipinary Action

    I understand that if my child or youth does not conduct his/herself in a Christ-like manner while attending events of Harvest Outreach Church, my child will receive disciplinary action. If that action includes being dismissed from the event, I will be responsible for transporting my child or youth home.
  • Powered by Jotform SignClear
  •  - -
  • Student Agreement

  • I, (students name)* agree to conduct myself in a Christ-like manner while attending the events of Harvest Outreach Church. I will attend all required meetings and cheerfully submit to those in authority over me. I will also obey any rule which may be implemented for a specific event. I realize that failure to adhere to these guidelines will mean disciplinary action and possible dismissal from the event and return home at my parent's expense.
  • Powered by Jotform SignClear
  •  - -
  • Medical Information

  • IN CASE OF EMERGENCY, and when I am unable to be contacted, I hereby give permission to the local physician to hospitalize, secure proper treatment for, order injection, anesthesia, or surgery for my child.

  • Students Name

  • Format: (000) 000-0000.
  •  - -
  • Emergency Contact Information

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Insurance Information

  • Format: (000) 000-0000.
  •  - -
  • Health History

  •  - -
  • Thank You!

    If you have any questions feel free to reach out to Pastor Toby!
  • All Information shared will be kept confidential and protected. Information will only be used in an emergency.

  • Should be Empty: