Parental/Guardian Consent

Bridge City First Student Ministries

Parental/Guardian Consent Form | 2026-27
STUDENT INFORMATION
Student Name

First NameLast Name
Do you have more students to add?
Second Student Name

First NameLast Name
Third Student Name

First NameLast Name
Fourth Student Name

First NameLast Name
Fifth Student Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState

Zip Code
Allergies (If None Type "N/A")
Chronic/Other Medical Conditions (If None Type "N/A")
Medications (If None Type "N/A")
Medical Insurance Company
Policy Number
Physician Name

First NameLast Name
Physician Phone Number
Please enter a valid phone number.Format: (000) 000-0000.

Parent/Guardian Information
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState

Zip Code
Email
example@example.com

Emergency Contact Info
1st Emergency Contact

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Relation to the Student
2nd Emergency Contact

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Relation to the Student

I Parent/Guardian the parent/guardian ofName of Student give permission for my child to participate in the program and activities of First Assembly of God and Bridge City First Student Ministries. I release all liability and indemnify First Assembly of God, Bridge City First Student Ministries and its directors, officers, agents, representatives, volunteers, and employees (“Church”) from any and all liability, claims and judgments, costs or expenses, including attorney fees, arising out of any damage, injury or illness incurred or caused by my child while participating in or traveling to or from the activity, or otherwise in Church custody.
I agree to instruct my child to cooperate with the Church and its representatives in charge of the activities and understand that my child may be prohibited from participating and/or sent home for any failure to follow the rules and program of the Church. I understand that the Church will be taking photos and will be filming footage of the program and activities. I acknowledge and consent for use of photographs and video footage of my son/daughter to be used in Church promotional videos, publications, and/or website without my written consent and without monetary compensation. I give authorization and permission to the Church to provide any necessary transportation, food, and lodging for my son/daughter. I appoint Church representatives who are acting as leaders, or designated by such leaders, as my attorney in fact to act for me in my name and on my behalf, in any way that I could act if I were personally present, with respect to the following matters if any injury, illness, or medical emergency occurs during the activity, related to travel or while my child is in Church custody. I understand that my own insurance is primary, and the church’s activity insurance is secondary.
1. To give any and all consents and authorizations to any physician, dentist, hospital or other persons or institutions pertaining to any emergency transportation, medications, medical or dental treatments, diagnostic or surgical procedures, or any other emergency actions deemed necessary or appropriate for the best interest of the child.
2. I understand the Church will make a reasonable attempt to contact me as soon as possible in the event of a medical
  emergency involving my child.
Parent/Legal Guardian
Today's Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
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Bridge City First Student Ministries

STUDENT INFORMATION

Parent/Guardian Information

Emergency Contact Info