Galilee Church Youth Ministry School Year Participation Form
Release and Waiver of Liability effective September 1, 2021 to August 31, 2022

This is a blanket permission form that covers all Youth Ministry activities.  If an activity requires its own, additional permission form, you will be notified.
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Student's Last Name *
Student's First Name *
Student's Preferred or Nickname
Student's email address
Birthday (month, day, year) *
MM
/
DD
/
YYYY
Year in School *
Mailing Address (Line 1 street address) *
Mailing Address (Line 2 town, state, zip) *
Primary Parent Email *
Second Parent Email
Mother's or Guardian's First and Last Name
Mother's or Guardian's best 10 digit contact phone number (no formatting)
Father's or Guardian's First and Last Name
Father's or Guardian's best 10 digit contact phone number (no formatting)
Emergency Contact First and Last Name *
Emergency Contact best 10 digit contact phone number (no formatting) *
Are there any physical and/or psychological ailments, allergies, limitations, or conditions of which the staff should be aware?  If yes, you will be contacted separately. *
Galilee Church has my permission to include my student in any photographs and/or videos for ministry and promotion reasons. I further understand that these photos and/or videos may be shared with staff, parents, on the Galilee Church website, social media, and others. *
When participating in online youth events my student has my permission to turn on and use their video camera which will project their picture to the group. *
I grant my permission for my student to attend and participate in all youth activities and events online or on Galilee Church property and/or any property of its volunteers, employees or representatives from September 1, 2021 through August 31, 2022. *
In the event that my student is ill, injured, or otherwise requires medical examination, care or treatment while under the care of Galilee Church and its representatives, employees or volunteers, I hereby consent to, and will be responsible for payment of charges for any emergency medical treatment or examination or such treatment or examination deemed necessary by a licenses physician. *
I further agree to release and hold Galilee Church and its representatives free and harmless of any claims, demands, or suits for damages arising from or be occasioned as a result of my child's participation in activities associated with Galilee Church Youth Ministry. *
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