TPP Minor Release

Minor Volunteer Release
Student's Full Name*

First NameLast Name
What Church or group are you with? Or which day of service are you serving?
What Church or Group are you serving with?*
Student's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number
E-mail
example@example.com
Birth Date*

MonthDayYear
Date

MonthDayYear
Age
Sex*
Grade*
T-Shirt Size (not applicable for all trips or days of service)*

Kids MediumKids LargeAdult SmallAdult MediumAdult LargeAdult XLAdult XXL
Statement of Rules and Expectations:

I also understand that all participants are expected to adhere to the following rules:

1. No use or possession of tobacco products, alcohol, or illegal drugs.

2. No use of inappropriate language will be permitted.

3. Cell phone use will be limited.

4. No leaving activity locations without permission from a leader.

5. Inappropriate displays of affection will not be permitted.

6. No disrespect to the adult leaders or other students will be tolerated.

I have completed the above, and have read these ruled and understand that if there are any disciplne problems with my child, that I am responsible for picking up my child from any activity of The Philadelphia Project at any time and location necessary.
Participant's Signature*

Clear
Insurance Co.
Policy #
Group #
Family Doctor Name
Allergy Information
We are unable to accommodate allergies in our meals, however we collect this information for reference and in case of an emergency.
Medications (over-the-counter and prescription)
Parent's Information
Parent Name*

First NameLast Name
Phone Number*
Address (if different from above)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Parent Phone Number*
Parent E-mail*
example@example.com
Medical Liability Release:

I, the undersigned, being the parent or legal guardian of the child named above (herein after "the child"), do hereby consent to the participation of my child in all of The Philadelphia Project & Roxborough Church ministry events. This include activities both on and offsite, including but not limited to mission trips and retreats. Further, I certify that my child is physically fit to participate in these activities.I also understand that I will be notified in the case of any medical emergency involving my child. However, in the event that I cannot be reached, I authorize the calling of a doctor and the providing necessary medical services in the event that my child is injured or becomes ill. I understand neither The Philadelphia Project, Roxborough Church, nor the ministry staff may be held responsible for medical expenses incurred, but that such expenses will be my responsibility as the parent/guardian.
Photo Release:

I, also grant permission to The Philadelphia Project & Roxborough Church to Publish pictures & videos of myself and/or the minor named above on The Philadelphia Project website, in promotional videos, press releases, or any other form of public publicity.
Parent/Guardian Signature*

Clear
Should be Empty:

Minor Volunteer Release

Parent's Information

Medical Liability Release:

Photo Release: