Overnight Event Waiver and Permission Form
Required for teenagers attending overnight events with Verndale Family Life Church
Guardian Contact Information
Guardian Full Name
*
First Name
Last Name
Guardian Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Guardian Email
example@example.com
Relationship to Student
*
Student Information
Student Full Name
*
First Name
Last Name
Student Birth Date
*
-
Month
-
Day
Year
Date
Pertinent Past Medical History
*
Waiver and Permission
Waiver Statement:
By signing below, I acknowledge that I am the legal guardian of the above-named student. I grant permission for my child to attend and be transported by Verndale Family Life Church for the overnight event. I understand and agree that Verndale Family Life Church and its representatives will not be held responsible or liable for any accidents, injuries, or incidents that may occur during the event or while in transit.
Guardian Signature
*
Submit Waiver
Submit Waiver
Should be Empty: