*Today's Date:(If your browser does not support a calendar picker. Date must be entered manually in YYYY-MM-DD format (e.g. 2019-12-25)
I give permission for *Son/Daughter Name to attend *Event Name: *Event Date: (If your browser does not support a calendar picker. Date must be entered manually in YYYY-MM-DD format (e.g. 2019-12-25)
from *Start Time: to *End Time: .
*If applicable, please list/explain any medical conditions/allergies/special needs/limitations that leaders/chaperones should be aware of (just fill in NA if not applicable):
If applicable, list medications currently taken: Self AdministeredSupervision/Help Needed
Medical Treatment Authorization I understand that I will be notified in the case of a medical emergency involving my son/daughter. However, in the event I cannot be reached, I authorize providing necessary medical services in the event my child is injured or becomes ill. I authorize a representative of Seaport Community Church including paid and volunteer staff to make emergency medical care decisions on behalf of my son/daughter, if required by law or a health care provider. I understand that the Church will not be responsible for medical expenses incurred solely on the basis of this authorization.
By signing below, you agree to all statements above and agree that your son/daughter is medically cleared and has your permission to participate in all activities associated with the event.
*Cell Phone Number:
In case of emergency if I cannot be reached please contact:
*Emergency Contact Name:
Emergency Contact Name: