NazKids Activity Waiver and Photo Release 2024-25

The undersigned does hereby give permission for the below mentioned student to attend and participate in the activities of my (our) choice that are associated with the Youth and Children’s Ministries at Mustang Nazarene Church during the school year of 2024-25. We, the parent(s)/guardian(s), do hereby release and will hold Mustang Church of the Nazarene, and any connected affiliate, harmless of any and all liability and claims resulting from any injury, loss, or accident that might occur to said minor(s) while participating in the activities affiliated with the church during the designated year. This release shall also constitute authority to the Leadership of Mustang Church of the Nazarene to consent for any doctor, nurse and/or hospital to administer medical aid and treatment for the minor if an accident is sustained or emergency exists. This includes any X-ray examination, anesthetic, surgical or dental diagnosis or treatment and hospital care.

Parent/Guardian Name

Parent/Guardian Email

This address will receive a confirmation email

Parent/Guardian Phone

Address

STUDENT Name

STUDENT Birthdate

Emergency Contact

Emergency Contact Phone Number

Does the Student have any allergies or need any special accommodations?

I give consent for pictures or videos of my student to be posted on social media or church publications.

Yes No

Parent/Guardian Responsible Party Digital Signature

Today's Date

NazKids Activity Waiver and Photo Release 2024-25

Description

Please Fix the Following