Child's Name *
Child's Name
Any Food Allergies or Medical Needs? *
Guardian Name *
Guardian Name
Home Phone
Home Phone
Cell Phone *
Cell Phone
Emergency Contact *
Emergency Contact
Phone *
Phone
MEDICAL AUTHORIZATION AND RELASE OF LIABILITY
As Parent/Guardian, I hereby give approval for my child to go to the above referenced activity with the Glad Tidings Children's Ministry. I further authorize the staff or designated medical professionals to administer emergency medical assistance if I cannot be reached. I do hereby release the Church of Glad Tidings Children's Ministry employees and volunteer assistants from any liability whatsoever arising out of injury, damage, or loss, which may be sustained by the aforementioned youth during his/her involvement during this outing. I also give the Church of Glad Tidings permission to take pictures of my child and use those pictures. *
Signature *
Signature
Date *
Date