2021-2022 Student Ministries Medical Release Form

Please fill out this form and click submit.
Parent/Guardian 1 Information

 
 
 
 
 
Parent/Guardian 2 Information

 
 
 
 
 
Student Information

 
Please select one option.
 
Student 2

 
Please select one option.
 
Student 3

 
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Health Insurance

 
 
Releases and Permissions

I hereby give permission for my student(s), to attend and participate in any student ministry activities during the period of September 1, 2021 – August 31, 2022.


Please select all that apply.

Should it be necessary for my student(s) to return home due to medical reasons, disciplinary action or otherwise, I shall assume all transportation costs and responsibility.

Please select all that apply.
In case of emergency, I give permission for the GREFC Youth Ministry Leaders to call emergency services and/or transport my child to medical services. 
Please select all that apply.
I give permission for my student(s) to ride in any vehicle driven by an approved and licensed adult leader while attending and participating in activities sponsored by Grand Rapids Evangelical Free Church.
Please select all that apply.
I give permission for photos and/or videos of my child to be taken and used for GREFC ministries. This includes printed materials as well as online sources.
Please select all that apply.
In case of accident or serious illness, I request the church to contact me first and then my emergency contact. If neither can be reached, I authorize the church to make whatever arrangements seem necessary. I understand that GREFC does not provide any form of health or accident insurance. I agree that I will not obligate GREFC paid or volunteer staff to pay any medical expenses related to such injury or illness. This form releases GREFC and any staff from any liability.
Please select all that apply.
I authorize approved adult leaders to administer the following if deemed necessary:
Please select all that apply.
 
 
I understand that my/our email addresses and phone numbers will be used for church purposes only and will not be distributed to any other organization without my consent. GREFC will not add my email address to a subscription list without my consent. My email and cell phone numbers will be used for church communications.
Please select all that apply.
 
 

Description

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