Event and Trip Consent Form

Field Trip Consent Form

Please complete this consent form for your minors to participate in field activities of the church outside our premises. Por favor llene esta planilla de consentimiento para que sus hijos menores participen en actividades de campo fuera del templo.

Minor’s Full Name:(required)

Health Card Number:(required)

Parent/Guardian Name:(required)

Emergency Contact Name:

Date of Birth:(required)

Family Doctor’s name:

Contact Number:(required)

Emergency Number:

Home Address:(required)

Date of Event/Trip:(required)

Time of departure:(required)

Mode of Transportation to and from Event:

Destination:(required)

Time of return:(required)

Please select the ministry:(required)

Children Ministry

Youth Ministry

Consent

I grant permission for my child to participate in the Event. I am aware that there are risks associated with participation, including the risk of injury, and I consent to my child’s participation in spite of such risks. I acknowledge that it is my responsibility to advise the church of any medical or other conditions which may affect my child’s participation in the Event. In case that my child requires medical attention, I consent to my child being transported and treated to the nearest emergency centre, including by ambulance if necessary, and accept that I am responsible for any costs of such services involved.

Disclaimer

I have and do hereby assume all risks, and hereby release Templo Nueva Vida and its leaders, and will hold them harmless from any and all liability, actions, causes of actions, debts, claims, and demands of every kind and nature, howsoever caused.

I have read and agree with this disclaimer.

Email address:(required)

Comments or health concerns if any:

Are you human?(required)

This field should be left blank