Wednesday Study Hall Consent Form
The following form is for students in grades 6th-12th to attend the Wednesday Study Hall located at Five Forks Brethren in Christ Church in Waynesboro, PA.
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What is the name of your student? *
What grade is your student in for the 2020-2021 school year? *
What is your relation to the student? *
Emergency Contact *
Emergency Contact Phone Number *
Form of Consent
By typing your name below, you are stating that Five Forks BIC Church is not responsible for personal or school property theft or damage. You are also consenting to the fact that this is a voluntary program whereby participants may come and go at will, therefore Five Forks BIC Church nor its representatives assume liability for the actions or injuries of participants on or off premises.

I understand that if my child does not adhere to the physical distancing guidelines set in place by Five Forks BIC Church, he/she may be asked to leave.
If you consent for your child to attend, type your name here. *
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