Consent and Liability

2021-2022 PARENTAL CONSENT & LIABILITY FORM

* Indicates required field

Parent(s) or Legal Guardian(s) Names *

First

Last

Name of student(s) attending trip *

MEDICAL INFORMATION & CONSENT

Parent(s) or Guardian(s) please sign name to give the the right to Mount Tabor Christian Church to authorize emergency medical treatment for my son or daughter *

Health insurance provider for student(s) *

ID or Policy Number *

Parent(s) or Guardian(s) Signature *

EMERGENCY CONTACT

Name *

First

Last

Phone Number *

Name *

First

Last

Phone Number *

Allergies and/or Medicines taken on the trip *

Submit