ELEVATE Student Conference: August 11-13, 2023
LIVING WORD CHURCH PARTICIPANT
Sign in to Google to save your progress. Learn more
I VERIFY THAT I AM THE LEGAL GUARDIAN COMPLETING THIS WAIVER. *
Required
Student Name: *
Student Gender *
Student Contact Number: *
Grade: *
Student Age: *
Student Shirt Size *
Payment $50 (cash or check only) *
Parent Name: *
Parent Contact Number: *
Back-Up Emergency Contact Name: *
Back-Up Emergency Contact Number: *
Medical Questionnaire: Is your child presently taking any form of medication for any reason?   *
If yes, explain and list medications.
Does your child have any allergies to food or medication? *
If yes, please list known allergies.
Does your child have (or ever had) any of the following? If none, CHECK NONE. *
Required
Explanation if any checked off other than none:
Can your child swim? *
Medical Treatment Authorization: We understand that we will be notified in the case of a medical emergency involving our child.  However, in the event that we or either of us cannot be reached, we authorize the calling of a doctor and the providing of necessary medical services in the event that our child is injured or becomes ill.  We authorize any adult leaders participating in this trip to make emergency medical care decisions on behalf of our child, if required by law or a health care provider.  We understand that Living Word Church, or any of their leaders, employees, or volunteers, will not be responsible for medical expenses incurred on the basis of this authorization. We agree to notify the church in the event of any health changes which would restrict our child’s participation in any activity. We also understand that the adult church representatives reserve the right to restrict our child from any activity that they do not feel is within the physical capabilities of my child.   *
Required
Consent (We) the undersigned, being the parent(s) or legal guardian(s) of the child named above, do hereby consent to the participation of my (our) child in a Living Word Church trip, including swimming, boating, hiking, sports events, and any other activities customarily associated with such a trip.  Further, I (we) certify my (our) child is physically able to and adequately trained to participate in any such events including swimming. *
Required
PLEASE SIGN ELECTRONICALLY VIA DOCUSIGN: CLICK ON THE LINK BELOW: AFTERWARDS, BE SURE TO CLICK THE PURPLE SUBMIT BUTTON ON THIS GOOGLE FORM FOR YOUR FORM TO BE PROCESSED.

Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Living Word Church. Report Abuse
Google Forms