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Teen Connection Permission Slip
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Teen Connection Permission Slip
Teen Connection Event Permission Slip
Parent's First Name
Parent's Last Name
Phone Number
Email
Child's Name (You Can Input More Than One Name)
Has My Permission To Attend The Event Listed Below:
If travel off HBC property is required, I give my consent. I have completed the required Horizon Baptist Church "In Case of Emergency/Travel Waiver" which is Located below and in effect for this event.
Yes
No
Any additional information about your child to help us?
I hereby waive, release, and absolve Horizon Baptist Church and any of its representatives acting individually or on behalf of the church from all liability for any and all injuries and /or illnesses incurred while participating in any and all activities during the event for which this waiver is intended. By completing and submitting this form I certify that I am the parent or legal guardian and I am authorized to provide this waiver and consent.
Submit
Completion of this section is for off campus travel only. It is required for all off campus travel.
Horizon Baptist Church In Case of Emergency/Travel Wavier
(Required for off property events and travel.)
Child's First Name
Child's Last Name
Date of Birth
Event Attending:
Emergency Contact First Name
Emergency Contact Last Name
Phone Number
Relationship
2nd Emergency Contact First Name
2nd Emergency Contact Last Name
Phone Number
Relationship
Is your child brining any prescription or over -the-counter drugs of any kind while on this trip?
Yes
No
Please give any and all medicines, along with precise dose and directions to the leader of the trip. Please list medical issues below and provide instructions for leaders to follow.
List any known medical conditions such as Diabetes, Epilepsy, Allergies (including to food or insects), physical impairments or any other condition which might or does require specialized attention.
Insurance Company
Policy Number
Family Physician
Phone Number
I have no knowledge of any physical or mental impairment that would prohibit my child from safely participating on this trip and the activities within it. I authorize the leaders of Horizon Baptist Church to act for me according to their best judgement in any emergency including the need for medical attention. I am aware transportation for my child will be provided by the church via church, rented or private vehicles. I hereby waive, release, and absolve Horizon Baptist Church and any of its representatives acting individually or on behalf of the church from all liability for any and all injuries and /or illnesses incurred while being transported or while participating in any and all activities on the trip for which this waiver is intended. By inserting my name and date below I certify that I am the parent or legal guardian and I am authorized to provide this waiver and consent.
Submit
