• Student Medical Form

    NEHBC Student Ministry
  •  -  - Pick a Date
  • EMERGENCY CONTACT 1

  •  -
  • EMERGENCY CONTACT 2

  •  -
  • MEDICAL CARE

  •  -
  • MEDICAL INSURANCE

  •  -
  • MEDICAL AUTHORIZATION

    In the event of a change in the medical condition of my student, I will notify in writing Northeast Houston Baptist Church (NEHBC) prior to my student's participation in future events. I understand that I can revoke this medical authorization at any time upon writing to NEHBC.

    I hereby give permission to NEHBC and the physician selected by NEHBC representative to secure medical treatment that may be deemed necessary to ensure my student's well-being (including hospitalization and surgery). I, the undersigned, do hereby release NEHBC from any and all claims, demands, actions or cause of action arising out of damage or injury while my student participates in NEHBC sponsored activities.

  • MEDIA USE AUTHORIZATION

    Every year, the NEHBC Student Ministry uses photographs and videos of our students for a variety of projects and media, including social media networks such as Facebook, Twitter, and Instagram. In addition, we may use photographs and videos of our students in our NEHBC Student Ministry App, and in printed publications.

  • TRANSPORTATION AUTHORIZATION

    NEHBC Student Ministry-sponsored events may include the transportation of students to and from the event location. Because we are committed to the safety of minors, at no time will students be permitted to ride with an adult for an NEHBC Student Ministry-sponsored activity who has not completed our Child Protection Training and a Driver's Background Check. Please indicate your authorization for the NEHBC Student Ministry to transport your student by signing below:

    I give permission for my student to be transported to and from NEHBC sponsored activites by the approved adult in whose care my student has been entrusted to while attending and participating in all NEHBC sponsored activities. I understand that these adults would include NEHBC Student Ministry staff and approved volunteers.

  • Medical Form - Student 2

  •  -  - Pick a Date
  • EMERGENCY CONTACT 1

  •  -
  • EMERGENCY CONTACT 2

  •  -
  • MEDICAL CARE

  •  -
  • MEDICAL INSURANCE

  •  -
  • MEDICAL AUTHORIZATION

    In the event of a change in the medical condition of my student, I will notify in writing Northeast Houston Baptist Church (NEHBC) prior to my student's participation in future events. I understand that I can revoke this medical authorization at any time upon writing to NEHBC.

    I hereby give permission to NEHBC and the physician selected by NEHBC representative to secure medical treatment that may be deemed necessary to ensure my student's well-being (including hospitalization and surgery). I, the undersigned, do hereby release NEHBC from any and all claims, demands, actions or cause of action arising out of damage or injury while my student participates in NEHBC sponsored activities.

  • MEDIA USE AUTHORIZATION

    Every year, the NEHBC Student Ministry uses photographs and videos of our students for a variety of projects and media, including social media networks such as Facebook, Twitter, and Instagram. In addition, we may use photographs and videos of our students in our NEHBC Student Ministry App, and in printed publications.

  • TRANSPORTATION AUTHORIZATION

    NEHBC Student Ministry-sponsored events may include the transportation of students to and from the event location. Because we are committed to the safety of minors, at no time will students be permitted to ride with an adult for an NEHBC Student Ministry-sponsored activity who has not completed our Child Protection Training and a Driver's Background Check. Please indicate your authorization for the NEHBC Student Ministry to transport your student by signing below:

    I give permission for my student to be transported to and from NEHBC sponsored activites by the approved adult in whose care my student has been entrusted to while attending and participating in all NEHBC sponsored activities. I understand that these adults would include NEHBC Student Ministry staff and approved volunteers.

  • Medical Form - Student 3

  •  -  - Pick a Date
  • EMERGENCY CONTACT 1

  •  -
  • EMERGENCY CONTACT 2

  •  -
  • MEDICAL CARE

  •  -
  • MEDICAL INSURANCE

  •  -
  • MEDICAL AUTHORIZATION

    In the event of a change in the medical condition of my student, I will notify in writing Northeast Houston Baptist Church (NEHBC) prior to my student's participation in future events. I understand that I can revoke this medical authorization at any time upon writing to NEHBC.

    I hereby give permission to NEHBC and the physician selected by NEHBC representative to secure medical treatment that may be deemed necessary to ensure my student's well-being (including hospitalization and surgery). I, the undersigned, do hereby release NEHBC from any and all claims, demands, actions or cause of action arising out of damage or injury while my student participates in NEHBC sponsored activities.

  • MEDIA USE AUTHORIZATION

    Every year, the NEHBC Student Ministry uses photographs and videos of our students for a variety of projects and media, including social media networks such as Facebook, Twitter, and Instagram. In addition, we may use photographs and videos of our students in our NEHBC Student Ministry App, and in printed publications.

  • TRANSPORTATION AUTHORIZATION

    NEHBC Student Ministry-sponsored events may include the transportation of students to and from the event location. Because we are committed to the safety of minors, at no time will students be permitted to ride with an adult for an NEHBC Student Ministry-sponsored activity who has not completed our Child Protection Training and a Driver's Background Check. Please indicate your authorization for the NEHBC Student Ministry to transport your student by signing below:

    I give permission for my student to be transported to and from NEHBC sponsored activites by the approved adult in whose care my student has been entrusted to while attending and participating in all NEHBC sponsored activities. I understand that these adults would include NEHBC Student Ministry staff and approved volunteers.

  • Medical Form - Student 4

  •  -  - Pick a Date
  • EMERGENCY CONTACT 1

  •  -
  • EMERGENCY CONTACT 2

  •  -
  • MEDICAL CARE

  •  -
  • MEDICAL INSURANCE

  •  -
  • MEDICAL AUTHORIZATION

    In the event of a change in the medical condition of my student, I will notify in writing Northeast Houston Baptist Church (NEHBC) prior to my student's participation in future events. I understand that I can revoke this medical authorization at any time upon writing to NEHBC.

    I hereby give permission to NEHBC and the physician selected by NEHBC representative to secure medical treatment that may be deemed necessary to ensure my student's well-being (including hospitalization and surgery). I, the undersigned, do hereby release NEHBC from any and all claims, demands, actions or cause of action arising out of damage or injury while my student participates in NEHBC sponsored activities.

  • MEDIA USE AUTHORIZATION

    Every year, the NEHBC Student Ministry uses photographs and videos of our students for a variety of projects and media, including social media networks such as Facebook, Twitter, and Instagram. In addition, we may use photographs and videos of our students in our NEHBC Student Ministry App, and in printed publications.

  • TRANSPORTATION AUTHORIZATION

    NEHBC Student Ministry-sponsored events may include the transportation of students to and from the event location. Because we are committed to the safety of minors, at no time will students be permitted to ride with an adult for an NEHBC Student Ministry-sponsored activity who has not completed our Child Protection Training and a Driver's Background Check. Please indicate your authorization for the NEHBC Student Ministry to transport your student by signing below:

    I give permission for my student to be transported to and from NEHBC sponsored activites by the approved adult in whose care my student has been entrusted to while attending and participating in all NEHBC sponsored activities. I understand that these adults would include NEHBC Student Ministry staff and approved volunteers.

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