Release Form for Off Site VBS Day Missions
Release Form for Off Site VBS Day Missions
(Grades 4 - 12 only).
Child's Name
I give permission for my child to participate in the local missions within Greenville, SC. I understand that my child will either ride in the church vehicle or will ride with one of our chaperones
The Under-initialed parent or legal guardian of stated child in attendance at functions of First Presbyterian Church, does hereby grant permission for said child to participate in all activities, trips, and programs in connection with First Presbyterian Church. I hereby acknowledge that my child is physically fit and capable of participating in all such activities. Transportation arrangements will be made under authorization of First Presbyterian Church and the trip will be under adult supervision. Since the activity, trip or program is arranged for the benefit of the participants, it is understood that First Presbyterian Church, it’s employees, and adult supervisors and volunteers will exercise caution, judgment, and care, but cannot be held responsible in case of accident, injury, and loss or damage of property in connection with the activity, trip or program, and the undersigned will hold them harmless from all such claims.
The Under-initialed further agrees to admonish the child participant to exercise care, to be well behaved and in all things to be obedient to and under the direction and control of those adults in charge. The Under-initialed also further agrees to inform the church immediately of any changes in the information presented on the release form. This release form is valid for the period mentioned above or until revoked by the Under-initialed.
Parent/Guardian Name
Parent/Guardian Initial:
Date
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MM
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DD
YYYY
Address
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Home Phone (###-###-####)
Work Phone (###-###-####)
Mobile Phone (###-###-####)
I hereby authorize the adult supervisors and any licensed physician permission to take all emergency steps that may be deemed necessary in case of an accident. As parent or guardian I hereby give my permission for emergency medical treatment for my child in the event I cannot be reached for authorization.
Parent/Guardian Initial:
Date
/
MM
/
DD
YYYY
Name of Child's Doctor
Doctor's Phone Number
Insurance Company
Insurance Policy Number
Insurance Company Phone Number
Please list any important medical information below (allergies, food allergies, medications, bee sting reactions, medical conditions, etc.)
In case Parent of Legal Guardian cannot be reached:
Emergency Contact Name
Emergency Contact Phone Number
Emergency Contact Relationship to Child
