Freshwater Student Info & Release Form

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Please submit one form per each student in your household.
Student Info
 
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Parent Info
If you are submitting multiple forms for multiple students in your household, it is only necessary to enter your CONTACT information on the first form submitted.  Please DO INCLUDE parent names on ALL submitted forms.
 
 
 
 
 
 
Legal Guardian Acknowledgement *

The Participant listed above has my permission to attend any events or activities sponsored by Freshwater Church Jefferson City and Freshwater Students Ministry within the dates of 1/01/2019 and 12/31/2019.

This consent form gives permission to seek whatever medical attention is deemed necessary, and releases Freshwater Church Jefferson City, and its staff and/or volunteer leaders of any liabilities against personal losses of named participant.

In checking the box below and entering my name as the Legal Guardian, I am stating that I have legal custody of the participant named above, a minor, and have given our consent for him/her to attend events being organized by Freshwater Church Jefferson City's Student Ministry. I understand that there are inherent risks involved in any ministry activity or athletic event and, I hereby release Freshwater Church Jefferson City, its pastors, employees, agents, and/or volunteer workers from any and all liability for any injury, loss, or damage to person or property that may occur during the course of the named participant’s involvement. In the event that he/she is injured and requires the attention of a doctor, I consent to any reasonable medical treatment as deemed necessary by a licensed physician. In the event treatment is required from a physician and/or hospital personnel designated by Freshwater Church Jefferson City, I agree to hold such person(s) free and harmless of any claims, demands, or suits for damages arising from the giving of such consent. I also acknowledge that I will be ultimately responsible for the cost of any medical care should the cost of that medical care not be reimbursed by the health insurance provider. Further, I affirm that the health insurance information provided above is accurate at this date, and will, to the best of my knowledge, still be in force for the participant named above. I also agree to bring the participant home at my own expense should they become Ill, or if deemed necessary by the Student Ministry staff.

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Description

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