First Pres Waiver & Medical Release
Good for the 2023-2024 School Year! Starting July 2023. 
Email *
Name of Child #1
Child #1 Birthday
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Child #1 Allergies
Name of Child #2
Child #2 Birthday
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DD
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YYYY
Child #2 Allergies
Name of Child #3
Child #3 Birthday 
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DD
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YYYY
Child #3 Allergies
Name of Child #4
Child #4 Birthday
MM
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DD
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YYYY
Child #4 Allergies
Additional Medical Information
Parent #1 Name
Parent #1 Phone Number 
Parent #2 Name
Parent #2 Phone Number
Additional Emergency Contact (Name and Number)
Address
Are you okay with pictures of your student being posted on the church website/social media? *
Are you okay with your student meeting with an adult from the church in a one-on-one setting in a public place?
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By typing your name you acknowledge and agree to the following:
I, the parent or guardian of the above child(ren) give my permission to the adult leadership of First Presbyterian Church to authorize emergency medical treatment for my child if the need arises.  I understand that every effort will be made to contact me.

Waiver of Responsibility

I, the parent or guardian of the above children, give my permission for him/her to participate and travel with the First Presbyterian Church and hereby release First Presbyterian Church and its leaders of any liability in the event of an accident.


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