SR. HIGH OVERFLOW

Student Name *

First Name

Last Name

Student Phone

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Parent/Guardian Name *

First Name

Last Name

Parent/Guardian Phone *

(###)

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Emergency Contact

First Name

Last Name

Emergency Contact Phone

(###)

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Permission *

Consent: For your information, we expect each student to conform to basic rules of conduct: No possession or use of alcohol, drugs, or tobacco; no fighting, use of weapons, fireworks, lighters, or explosives. Voluntary participation, respect for property, schedule, one another, staff, adult leaders is expected. Students who fail to comply with these expectations may be sent home at their parents' expense. Off-site activities carry increased risks beyond the scope of an in-house youth night. By signing this release, you acknowledge that you understand the risks involved, and hereby release Calvary Pentecostal Church, it’s pastors, employees, volunteers, and drivers from any liability for injury, loss, damage to person or property that may occur during the course of your child’s involvement in this event, including transportation to and from the event. Should your child become ill, or if deemed necessary by the church or its leaders due to noncompliance with the above stated rules, you also agree to bring your child home at your expense.

I have read and agree.