707 Cedar Point, August 28, 2023
Student Name
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First Name
Last Name
Insurance Company and Policy Number
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Under the Name of:
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First Name
Last Name
Relationship to Student
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Please list any allergies/medication/Mental or dietary Condition that we should be aware of:
OPC Milford staff/volunteers are allowed to give my child over the counter Medication for minor aliments
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Yes
No
In case of medical emergency or general medical care, I give consent for medical treatment for my child named above by authorized personnel. I certify the above child has my permission to travel to Cedar Point with the Oak Pointe Church High School Ministry on August 28, 2023. I understand that my child will ride in rented and/or church owned vehicle and/ or volunteer vehicles and that Oak Pointe Church High School Staff/Volunteer will do all they can to ensure a safe and fun activity. I agree to indemnify and hold harmless Oak Pointe Church Milford, its employees and volunteers from any liability to or responsibility for injury, damage, or illness to the above identified child while participating in this event.
Parent Signature
Parent/ Guardian Signature
Parent Name
*
First Name
Last Name
Date
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Month
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Day
Year
Date
Submit
Should be Empty: