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ELEVATE Beach Trip - August 4, 2018

Parent/Guardian Name: *

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Child's Name : *

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Date: *

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Emergency Contact Number *Please enter your phone number.

By checking this box, I certify that I am the parent or legal guardian of the listed child(ren). I hereby release and agree to hold harmless DOVE Westgate Church and all representatives thereof from any and all liability, claims, and demands for injury, sickness, or death which may be incurred by my child(ren) in the course of participation of the ELEVATE Senior High Beach Trip on August 4, 2018. I give authorization for the church to obtain medical treatment if necessary. I also give permission for pictures to be taken during the Beach Trip for the sole purpose of future promotions at DOVE Westgate Church. Additionally, DOVE Westgate Church requires compliance with all rules and regulations set forth by the leadership of ELEVATE Youth, including those regarding conduct, dress and Christian lifestyle and strict adherence will be expected. Failure to do so could result in my child's dismissal from the event, upon which I will be expected to provide immediate retrieval of the child from the event. By checking this box I am indicating my agreement with all of the above. *Please check it here.

Physician's Name and Phone: Please enter your answer here.

Insurance Company: Please enter your answer here.

Policy Holder and Number: Please enter your answer here.

Parent/Guardian signature: *

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