Eastside Church Ice Skating Event – Parental Permission & Medical Consent
Please complete this form prior to participating in the Eastside Church Red Robin Lunch and Ice Skating Event. Also, bring $25 cash or write checks to Eastside Church.
Student’s Name
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First Name
Last Name
Student’s Age
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Parent or Guardian’s Name
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First Name
Last Name
Parent or Guardian’s Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
PERMISSION & BEHAVIOR AGREEMENT: I give permission for my child (or myself, if 18 or older) to participate in the Eastside Church ice skating event. I understand that all participants are expected to follow event rules and instructions from leaders and skating facility staff. Disruptive, unsafe, or inappropriate behavior may result in removal from the event at the parent/guardian’s expense. Event fees are non-refundable.
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I Agree
I Do Not Agree
ASSUMPTION OF RISK & RELEASE OF LIABILITY: I understand that ice skating is a physical activity that involves inherent risks, including but not limited to falls, collisions, and injury. I voluntarily assume all known and unknown risks associated with participation. To the fullest extent permitted by law, I release and hold harmless Eastside Church, its staff, volunteers, leaders, agents, and representatives from any and all claims, injuries, illnesses, damages, or loss of property arising from participation in this event or transportation arranged by Eastside Church, except in cases of gross negligence or willful misconduct. This release applies to the participant, as well as parents, guardians, heirs, and representatives.
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I Agree
I Do Not Agree
MEDICAL AUTHORIZATION: In the event of an emergency, I authorize Eastside Church leaders to obtain medical treatment for my child or myself if I cannot be reached. This includes emergency medical care, transportation, and treatment deemed necessary by medical professionals. I understand that I am financially responsible for any medical care provided and that Eastside Church does not provide medical insurance coverage for this event.
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I Agree
I Do Not Agree
PHOTO & MEDIA RELEASE: I grant permission for Eastside Church to take and use photographs or video of the participant for church-related purposes, including promotion and communication, without compensation.
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I Agree
I Do Not Agree
Parent or Guardian’s signature
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Date
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Year
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Participant Signature (if 18 or older)
Date
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Month
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Year
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Should be Empty: