New Life Early Education ACTIVITY WAIVER
Studio Movie Grill: Trolls Aug 6th
The undersigned parent/legal guardian hereby gives permission to New Life Church, for my child:
To take part in the following activity: Please add name of field trip Ex: Splash Pad
Should my child require immediate or emergency medical care while engaged in an activity sponsored by the Church, in my absence, I hereby grant the Church authority to release my child for medical treatment to such medical personnel as the Church determines appropriate under the circumstances.
In consideration for the privilege of allowing my child to participate in the above-named activity, I agree to release and hold harmless the Church, its officers and agents, from any liability to or responsibility for bodily injury, damage or illness to the above-identified child while participating in any youth athletic or social activity which may be directly or indirectly sponsored by the Church. Further, I agree to indemnify and hold harmless the Church, its officers and agents with respect to any claim asserted by or on behalf of my child as a result of bodily injury, illness, or damage.
Child (ren)'s Allergies:
PLEASE READ CAREFULLY, THIS PERMISSION SLIP IS A LEGAL DOCUMENT WHICH INCLUDES A RELEASE OF LIABLITY AND INDEMNIFICATION
Date
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Month
-
Day
Year
Date
Signature of Parent or Legal Guardian
Telephone number Home or Mobile
Format: (000) 000-0000.
Telephone number Work:
Format: (000) 000-0000.
Emergency Contact Name:
Emergency Contact:
Format: (000) 000-0000.
Special instructions or medical conditions:
The above signed parent or legal guardian has the following form of health/accident insurance covering the child:
Company
Member Number
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Should be Empty: