Equipping believers for a world-wide ministry

RELEASE FORM

NAME OF CHILD (Under 18) ____________________________________________________

ADDRESS _____________________________________________________________________

TELEPHONE __________________________________________________________________

Has my permission to participate in the following activity:

_______________________________________________________________________________

_______________________________________________________________________________

I understand that every reasonable precaution will be taken for the health and safety of my child and release Trinity Evangelical Free Church from liability.
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Signature (parent or guardian)

In case of emergency, please notify:

_______________________________________________________________________________

_______________________________________________________________________________

Are there any medicine(s) are physical problems? Please list be below medicine(s) and/or illness:

_______________________________________________________________________________

I, _________________________________________, do hereby give my permission for the above child to receive emergency medical treatment while on this trip with Trinity Evangelical Free Church Youth Group on the date(s) of:

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STATE OF FLORIDA
COUNTY OF LAKE

SWORN TO AND SUBSCRIBED BEFORE ME BY: _____________________________________________

on this ________ day of ________________________________, ____ ______.

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(Signature of Notary Public)
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Notary Public (Print Name)
My Commission Expires: _________________________

Personally Known _______ / ID_______ Type of ID _____________________________________________