First B

Big Weekend 2016 Permission Slip


First Baptist Church of Eugene
Permission Slip

 

 

I, , give permission for to attend the 1st B Kids B Kids Big Weekend , May 20th—22nd, 2016.

Further, as parent or guardian of the minor named above, I do hereby expressly consent that my son/daughter may receive emergency medical treatment from any physician, hospital, or other medical center without the necessity of first notifying me, and do further agree to hold blameless any physician, hospital or other medical center for rendering such services.

Additionally, I give my authorization to First Baptist Church of Eugene to record and photograph the likeness of my child, the above participant for promotional media use, not limited to brochures, videos, and online.  I am fully aware and understand this authorization.

 

Child Name:   

Parent Name:

Parent Cell Phone #:

 

Insurance Info

 

 

 

Please list anything that might limit your child from participating in activities such as zip-line, rock-wall, horses, go-carts, flying squirrel, or any other strenuous activity. Please also list any allergies or medical needs including medication that may be needed on activity below or on backside. If you do not want your child/teen participating in particular activities (i.e. jumping on trampoline) please list that as well.

 

My signature confirms that I hereby give witness to the proper completion of this form by the minor’s parent or guardian.

 

Leave this empty:

Signature Certificate
Document name: Big Weekend 2016 Permission Slip
Unique Document ID: 66c159eb5a443c16551db1aef06792c1a7501b2d
TimestampAudit
2016-05-11 18:24:22 PDTBig Weekend 2016 Permission Slip Uploaded by FBC Eugene - jacobj@fbceugene.com IP 173.164.127.170