Student All Year Participation Waiver

Student Ministries All Year Participation Form
Waiver

I/We give consent for the minor listed below to attend any event sponsored by Community Fellowship Student Ministries (CFSM) from August 1, 2017-August 30, 2018.

I/We give consent for CFSM to use photo or other digital reproduction of said minor for publication processes, whether electronic, print, digital or electronic via the Internet.

In the event that he/she is injured while under the care of Community Fellowship and its representatives and requires the attention of a doctor, I/We hereby consent to and will be responsible for any reasonable medical treatment as deemed necessary (including injection, medication, anesthesia, surgery, hospitalization or such other medical practices) by a licensed physician.

I/We further agree to hold the licensed physician, the medical facility, Community Fellowship and its representatives free and harmless of any claims, demands, or suits for damage arising from the authorization and provision of such medical treatment

I/We agree to cover all costs if our student needs to be sent home for any disciplinary reasons.

I/We understand that all transportation will be provided by one or more of the following: (1) personal vehicle driven by parent of student ministry adult sponsor, (2) rented van driven by parent or student ministry adult sponsor, or (3) chartered bus.

Student Information

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Address

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Family Information

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Medical Information

Please bring your insurance card into the office so we can make a photo copy for our files.

Allergies, medications, or medical information that needs to be known about the student

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Insurance Company Address

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If you have any questions, contact Jake Andrews at jandrews@commfell.org or 630-562-9184 x210