New 2023/2024 Youth Release/Permission Form

Child/Youth's Name

Birthday

Age

Grade

Address

Parent/Guardian 1 Name

Parent/Guardian 1 Email

This address will receive a confirmation email

Parent/Guardian 1 Cell Phone

Parent/Guardian 2 Name

Parent/Guardian 2 Email

Parent/Guardian 2 Cell Phone

Family Physician

Allergies (If none please type N/A)

Medical Insurance

Policy Number

Emergency Contact Person (not parent or guardian)

Relationship to child/youth:

Cell Phone:

Other Important Information that we need to know:

I give my permission to have photos of my child/youth displayed on Trinity's website, worship services, and social media:

Yes No Option

I (we), the undersigned parent(s) or guardian(s) of the above-named child/youth, do hereby release and discharge the TRINITY PRESBYTERIAN CHURCH and its representative and staff from all liability of any kind, upon any claim or course of action which might be asserted on behalf of said minor against said church, representative, or staff. Furthermore, in the event of an accident, if staff is unable to contact a parent or guardian, I (we) hereby grant permission to said staff to administer necessary first aid and/or to take the child/youth to the nearest hospital or medical facility for additional treatment. Please type name and date:

Parent/Guardian Name:

and date:

Description

Please fill out this form and click submit. A separate release/permission form is required for each participant.

New 2023/2024 Youth Release/Permission Form

Description

Please Fix the Following