2003 confirmation registration form

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Valley Fair Permission Slip (Grades 7-12 for\ 2018-19 school year) Wednesday, July 11th 10:00am-7:00pm (meet at church; pick up at church) Cost: $35 (only $8 for season pass holders!) Checks to “SOC” STUDENT’S FULL NAME____________________________________ Date of birth______________ Gender (circle one): M

F

School__________________ Grade (’18-’19)___________

Parent(s)/Guardian(s)_________________________________________________________________ Home phone: _______________________________ Parent cell phone:__________________________ Parent email:_________________________________________________________________________ Allergies, illnesses, physical limitations, pre-existing conditions, current medications, personality changes/mood swings or any medical or special needs your child has of which the confirmation staff should be aware: ____________________________________________________________________________________ As the parent/legal guardian of this student, I grant permission for him/her to participate fully in the Valley Fair event. If I cannot be reached in an emergency, I give permission to the supervising staff and/or leaders of Servant of Christ to sign forms that would ensure the necessary and immediate treatment of my child. I understand that neither Servant of Christ nor those acting on behalf of Servant of Christ will be held liable in case of accident or injury as long as there is no gross negligence. I give permission for this student to leave the premises of Servant of Christ for this event either in a vehicle of an adult guide or in a rental bus/church bus. I grant Servant of Christ permission to use photos of my child without compensation or prior notification. If these rules are broken, I will assume the transportation costs to return my child home immediately by the safest means. Medical Insurance Company_____________________________________________________________ Insurance Company Address____________________________________________________________ Policy/Group #____________________________________________Phone ______________________ Emergency Contact (parents will be contacted first) Name___________________________________________________Phone_______________________ Cell Phone____________________________

Parent/Guardian Signature_____________________________________Date____________________ Student Signature____________________________________________Date____________________

Due Sunday, July 8th at 12:00pm