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    Little Shop of Horrors

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    NerlynnEt
    This document contains a consent form for a youth activity trip hosted by Agape Christian Fellowship's Generation Impact (G.I) Youth Ministry. The form provides details about an upcoming trip for students to see "Little Shop of Horrors" including the date and time of departure, location, fees, and medical and liability release information. Parents are asked to provide contact and insurance details for their child and to sign giving permission for their child to attend as well as consent to emergency medical treatment if needed.

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    Download as PDF, TXT or read online from Scribd

    Little Shop of Horrors

    Uploaded by

    NerlynnEt
    84 views1 page
    This document contains a consent form for a youth activity trip hosted by Agape Christian Fellowship's Generation Impact (G.I) Youth Ministry. The form provides details about an upcoming trip for students to see "Little Shop of Horrors" including the date and time of departure, location, fees, and medical and liability release information. Parents are asked to provide contact and insurance details for their child and to sign giving permission for their child to attend as well as consent to emergency medical treatment if needed.

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    This document contains a consent form for a youth activity trip hosted by Agape Christian Fellowship's Generation Impact (G.I) Youth Ministry. The form provides details about an upcoming trip for students to see "Little Shop of Horrors" including the date and time of departure, location, fees, and medical and liability release information. Parents are asked to provide contact and insurance details for their child and to sign giving permission for their child to attend as well as consent to emergency medical treatment if needed.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    84 views1 page

    Little Shop of Horrors

    Uploaded by

    NerlynnEt
    This document contains a consent form for a youth activity trip hosted by Agape Christian Fellowship's Generation Impact (G.I) Youth Ministry. The form provides details about an upcoming trip for students to see "Little Shop of Horrors" including the date and time of departure, location, fees, and medical and liability release information. Parents are asked to provide contact and insurance details for their child and to sign giving permission for their child to attend as well as consent to emergency medical treatment if needed.

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    AGAPE CHRISTIAN FELLOWSHIP

    8270 Buckingham Road, Fort Myers, FL 33905 www.acfconnect.org (239) 791-8876


    Generation Impact (G.I) Youth Ministry Activity Consent Forms
    Students Name: __________________________________________ Date of Birth _____/______/______

    Parent/ Guardian: _________________________________________ Are you attending this event?: YES NO

    Address __________________________________ City_______________________ State_____ Zip___________

    Parent Phone (Home) _________________________ (C) ______________________________

    Parent (W) ________________ (Alt) __________________________

    Students Cell Phone Number _____________________________________

    Email address _________________________________________________________________________________

    Does Your Child have Medical Insurance: YES NO (please circle one)

    Medical/ Dental Provider ________________________ ____________________________

    Date & Time: Saturday, November 15, 2014 11:00 A.M. 11:00 P.M.

    Logistics: Transportation via church van, departing from ACF parking lot at 11:00am.

    I hereby give permission for _____________________________________ to attend the Little Shop of Horrors
    with G.I Youth Ministry, Westcoast Black Theatre Troupe,1646 10
    th
    Way, Sarasota, FL 34236,
    Fees: Adults $45, Teens $35. This includes lunch, ticket, and transportation. Payments received after Wednesday,
    September 3, 2014 must include a $15 late fee

    Medical restrictions Special considerations or restrictions: ____________________________

    My Child has allergies to the following foods, insect bites or stings________________________________

    Hold Harmless Agreement

    I understand that participation in certain G.I activities can involve a certain degree of risk and can be
    physically, mentally, and emotionally demanding. I have carefully considered the risk involved in this current
    activity and have given consent for myself or my child to participate in this activity. I also understand that
    participation in this activity is entirely voluntary and requires participants to abide by applicable rules and
    standards of conduct. I release the Agape Christian Fellowship, G.I Youth Ministry, Youth Leaders, and all
    ACF employees, volunteers and chaperones associated with the activity from any and all claims or liability
    arising out of this participation.

    In case of emergency involving my child, I understand every effort will be made to contact me. In the event I
    cannot be reached, I hereby give my permission to the emergency medical provider selected by the adult
    leader in charge to secure proper treatment, including hospitalization, anesthesia, surgery, or injections of
    medication for my child. Medical providers are authorized to disclose to the adult in charge examination
    findings, test results, and treatment provided for purposes of medical evaluation of the participant, follow-up
    and communication with the participants parent or guardian, and/or determination of the participants ability
    to continue in the field trip activities.

    Participants Signature: ________________________________ Date __________________________

    Parent / Guardian Printed Name: ________________________________________________________

    Parent / Guardian Signature: ___________________________ Date___________________________

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