2024 Medical/Discipline/Media Release
This form is required for any participant on any church sponsored trip, function or event. This form will be used for all trips or events during that particular year. If there are changes throughout the year, it is the responsibility of a parent or legal guardian to complete an updated form each calendar year.
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Email *
Participant's First and Last Name *
Birth Date *
MM
/
DD
/
YYYY
Age *
Address (Street/City/Zip/State) *
Contact Phone Number (Student or Parent if under 18) *
Example: (555)555-5555
If Participant is under 18 years of age, please fill out the information below
Parent/Guardian's Name 
* Required If participant is under 18 years of age
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