Event Permission Slip
Please fill out this form and click submit.
Event Title
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Where is the event being held?
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Student Name
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I understand that, in the event my child requires medical or dental treatment while engaged in this activity, reasonable efforts will be made to contact me; however, if I cannot be reached, I hereby consent and give permission to this ministry or any adult counselor acting on behalf of this ministry with respect to this activity, as agent for me, to consent to any x-ray examination; injections; anesthesia; medical, dental or surgical diagnosis and treatment; and hospital care and treatment advised and supervised by a physician, surgeon, or dentist licensed under the laws of the State where the services are rendered, either as an outpatient or in any hospital. To the best of my knowledge, I have listed above all of my child’s medical allergies, medications being taken, medical problems, and other pertinent information. My child has permission to participate in all prescribed activities except as noted by me. I hereby, remise, release, and forever discharge NORTH POINT COMMUNITY CHURCH, its agents, servants, and all other persons, firms, and corporations whomsoever of and from any and all actions, claims and demands, whosoever which might happen while on the way to and from or on premises during NPCC Student Event. I am over eighteen years of age, and legally competent to execute this medical consent and release; and that before signing this claimant has fully informed himself/herself of its contents and meaning and has executed it with full knowledge thereof.
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Please select one option.
Yes
No
Pictures of my student may be taken and used on North Point Community Church’s website or media?
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Please select one option.
Yes
No
Has anything changed medically for your student(s) since our last event? If so, please fill out/update the medical information form.
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Please select one option.
Yes
No
Parent/Guardian Signature (Type Name or Names)
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Date of Signature
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Relationship to Student/Minor
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Submit
Description
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