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Convention Permission Form

Here is the corrected convention form! Please do not forget that Convention Money is due by Sunday October 11th!

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Praise Student Ministry
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© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
38 views

Convention Permission Form

Here is the corrected convention form! Please do not forget that Convention Money is due by Sunday October 11th!

Uploaded by

Praise Student Ministry
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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2015 Convention Permission Form

Student/ParticipantName_____________________________________DateofBirth____________Sex_____

Parent/GuardianName___________________________Parent/GuardianName____________________________

HomeAddress__________________________________HomeAddress____________________________________

HomePhone____________________________________HomePhone____________________________________

Work/CellPhone________________________________Work/CellPhone_________________________________

th
Student&LeaderCost(
$100.00
by
OCTOBER11
)

th th
DateofEvent/FieldTrip:
Nov.13
14TypeofFieldTrip:
YouthConvention

Destination:
Event:5300NorthOceanBlvd./MyrtleBeach,SC29577
th
th
EstimatedTimeofDeparture:
Nov.13
3:00PM
Return(Approximately):
Nov.14
7:30PM

Individual(s)/inCharge:
PastorConradMeier
ModeofTransportation:

CharterBus/VanRental
EMERGENCYMEDICALTREATMENT
:Intheeventofanemergency,Igivepermissiontotransportmychildto
ahospital.Iagreetoallowmychildtoreceiveemergencymedicaltreatmentatmyexpenseatthediscretionofthe
eventsponsor.Iwishtobeadvisedpriortoanyfurthertreatmentbyadoctororhospital.Intheeventofany
emergency,ifyouareunabletoreachmeattheabovenumbers,contact:
______________________________________________________________________ __________________
Name

Relationship

PhoneNumber

HEALTHINFORMATION
:

Medicationmychildistakingatpresent_____________________________________________________________

Forheadacheorminorpain,mychildmaybegiven___________________________________________________

Allergies______________________________________________________________________________________

OtherMedicalConditions_________________________________________________________________________

InsuranceCompany_________________________FamilyHealthPlancarriernumber______________________

FamilyDoctor____________________________________________PhoneNumber________________________

I,__________________________________,GIVEPERMISSIONFOR_____________________________

ParentorGuardianName

ChildName

TOPARTICIPATEINTHEABOVEDESCRIBEDEVENT
.
Iwarrantthatmychildisingoodhealth.Inconsiderationofmychilds
participation,Iagreetoindemnify
PraiseAssemblyofGod/PraiseStudentMinistry
fromanyclaimsorlawsuitsbroughtbymyself,
mychild,orothers,thatarisesoutofanybehaviorbymychildattheevent/activitydescribedabove.Ialsoagreetopayreasonable
attorneysfeesorexpensesincurredby
PraiseAssemblyofGod/PraiseStudentMinistry
indefenseofsuchaclaim/suit.

Iagreetodropmychildoffatthedeparturelocationatleast15minutespriortodepartureandtoprovidetransportationhomeatmy
expense.

IagreethatIamresponsibleformychildsconductandactions.Theeventsponsorisnotresponsibleforanyinjuryordamage
incurredorcausedbymychild.IunderstandthatmychildisrequiredtocomplywiththeCodeofConductprovidedby
Praise
AssemblyofGod/PraiseStudentMinistry
whileparticipatingintheevent.IunderstandthatifmychildviolatestheCodeofConduct
he/shemayberequiredtobetransportedhomeatmyexpense.

Parent/GuardianSignature
___________________________________________ Date
___________________

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