Permission Slip. More Than Conquerors Church. L.W.A.P. Overnight Retreat.
APRIL 13-14, 2012. REGISTRATION AND PERMISSION SLIP. NAME ...
Permission Slip
More Than Conquerors Church
L.W.A.P. Overnight Retreat APRIL 13-14, 2012 REGISTRATION AND PERMISSION SLIP
NAME ______________________________________________________________________________ HOME ADDRESS ___________________________________________ PHONE __________________ CITY/STATE _______________________________________________ ZIPCODE ________________ EMAIL ADDRESS ____________________________________________________________________ GRADE ________________________ BIRTHDATE ________________________________________ HOME CHURCH _____________________________________________________________________ PARENT NAME _____________________________________________ PHONE _________________ EMERGENCY CONTACT NAME _______________________________ PHONE ________________ ALLERGIES _________________________________________________________________________ Please bring copy of completed registration form, sleeping bag or blanket, pillow, personal toiletries, and ideas. Please DO NOT bring IPods, IPads, or other distracting electronic devices. Cell phones are permitted, but will be stored away during fellowship time. Cost per person is $15.00 and should be paid at the time of registration. Acceptable forms of payment are cash or check (make payable to More Than Conquerors Church) Code of Conduct: 1. Participants will not bring or use drugs (except for appropriate meds), tobacco, or alcohol at any MTC event. 2. Participants will not engage in sexual activity at any MTC events. 3. Participants will focus on inclusive behavior and will avoid exclusive relationships in order to build a unified youth group. 4. Participants will not bring or use fireworks, weapons, or other objects of a harmful nature at any MTC event. 5. Participants will be respectful of the building and property of retreat hosts and other participants. 6. Participants agree to abide by guidelines and respect the direction of youth leaders and volunteers. 7. All Participants — youth, guests, youth leaders, and volunteers — will share in the responsibility of establishing and maintaining an atmosphere of respect, trust, safety, and community. 8. Participants will not be permitted to wear, short shorts, shirts with stomach exposed, or any clothing with beer, alcohol, cursing, or any offensive ethnic or religious sign of any kind. 9. By signing a parental consent form, parents indicate that they retain their responsibility and liability for any injuries/illness sustained at any event attended by their child.
Permission Slip
More Than Conquerors Church
PARENTAL PERMISSION/AUTHORIZATION FORM Event: Ladies With A Purpose – “Walking In God’s Purpose” Place: More Than Conquerors Church, 3420 Holland Rd, Virginia Beach, VA 23452 Date: April 13-14, 2012 Participant Name: ____________________________________________ Birth date: ___________________________ Age ___________________ I give permission for my child to attend the More Than Conqueror Church event listed above. Medical Release I hereby request and authorize More Than Conqueror Church, the hospitals, licensed medical or dental providers, and their agents and employees to have access to the information contained in this form and to provide all medical or dental care, routine tests, treatment, and necessary transportation advisable for the health and safety of my child if necessary. This authorization includes the authority to consent to any x-ray examinations, anesthetic, medical procedure or treatment, and hospital care under the supervision, and upon the advice of or to be rendered by, a physician or surgeon licensed under the Medical Practice Act for my child. Insurance Company Name ___________________________________ Policy # ________________ Liability Release I further release liability of any illness or injury of my child and trust the Director of Youth Ministries and all designated adult representatives of More Than Conquerors Church to protect and care for appropriately the child I leave in their custody for this event. Activity Release I further give permission for my child to participate in all supervised activities except as noted: ______________________________________________________________________________ ______________________________________________________________________________
Signature of Parent or Legal Guardian ________________________________________ Printed name of Parent or Guardian & Date ____________________________________ Parent Home Phone #:___________________ Cell #___________________
