Journey Community Church
1534 Highway 96 South
Lumberton, TX 77657
409-755-1388
PERMISSION Form FOR MINORS
PARTICIPANT INFORMATION
Full Name:
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Birthdate:
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Grade:
Home Phone:
Format: (000) 000-0000.
Parent Cell Phone:
*
Format: (000) 000-0000.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent/Guardian Name(s):
*
PARENTAL AUTHORIZATION
Dear Parent or Legal Guardian:
Your son/daughter is eligible to participate in an activity that may require transportation away from the church site. This activity will take place under the guidance and direction of Journey Community Church
DESCRIPTION OF ACTIVITY
Event: Toledo Bend Lake Retreat
Location: Toledo Bend Reservoir
Activity Leader: Taylor Schooley
Date of Event: 05/15/26
Date of Return: 05/17/26
Mode of Transportation To/From Event: Van/Truck
Cost of Event: $50.00
Time of Departure: 9:00 a.m.
Time of Return: 1:30 p.m.
I hereby consent to participation by my son or daughter, in the event described above. I fully understand that this event may take place away from the church grounds and that my child will be under the supervision of the designated staff and/or volunteers on the stated dates. I understand that such an undertaking involves an element of risk. I assume all risks and hazards incidental to such participation and do hereby release, absolve, indemnify, and agree to hold harmless Journey Community Church, and its agents from any and all liability that may arise out of participation in this activity. I give consent for emergency medical treatment if necessary, as determined by the trip chaperones. I agree to hold harmless and release Journey Community Church and its agents from any and all liability related to expenses arising from the giving of such medical care. As parent/legal guardian, I remain fully liable for any legal responsibility which may result from any personal actions taken by the named participant.
I hereby grant permission to Journey Community Church to use my child's likeness on its promotional materials including, but not limited to videos, websites, and printed materials without further consideration, and I acknowledge Journey Community Church right to crop or treat the likeness at its discretion.
I consent to the conditions stated above, including the method of transportation.
Parent's/Guardian's Signature:
*
Date:
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Month
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Day
Year
Date
Telephone #:
*
Format: (000) 000-0000.
Night:
Format: (000) 000-0000.
Alternate Emergency Contact:
*
Telephone #:
*
Format: (000) 000-0000.
Night:
Format: (000) 000-0000.
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