Holy Spirit YM Online Liability Form

Holy Spirit Youth Ministry Liability Form

Holy Spirit Youth Ministry Liability Form

MEDICAL INFORMATION AND PARENTAL/GUARDIAN CONSENT FORM/LIABILITY WAIVER

Participant Name
Date of Birth
Gender
Grade
Home address, City, State, Zip
Home phone
Business phone
Cell Phone
Email
Participant Signature
Date
Parent/Guardian signature
Date
Emergency Contact Name & relationship
Emergency Contact Name phone
Child’s Family doctor
Phone of Doctor
Family Health Plan Carrier
Policy #
Medication 1 and dosage
Medication 2 and dosage
Parent/Guardian signature
Date
allergies
diet
physical limits
medical conditions

Parental/Guardian Statement of Intent for the Use of Social Communications and Personal Representation

CERTIFICATION, ACKNOWLEDGEMENT AND AUTHORIZATION FOR CONSENT AND RELEASE FORM FOR SOCIAL MEDIA OR OTHER ELECTRONIC COMMUNICATION INVOLVING MINORS AND INDIVIDUALS AT RISK
age
digital communication permission
Parent/Guardian signature
Date