Heirloom Farm Service Trip

Name of Student

Attenders Phone

Attenders Date of Birth

Address

Guardian/Emergency Contact Name

Guardian/Emergency Contact Phone

Parent/Guardian Email (or yours if a leader)

This address will receive a confirmation email

Secondary Emergency Contact and Phone Number

Health Insurance Carrier and Policy Number

Any Allergies/Disabilities/Meds?

I understand all reasonable safety precautions will be taken at all times by Faith Community Church and its agents during the event and activities. I authorize any treatment by an accredited hospital and/or physician deemed necessary for the subject of the release in case of an emergency. I understand the possibility of unforeseen hazards and know the inherent possibility of risk. I agree not to hold Faith Community Church, its leaders, employees, and volunteer staff liable for damages, losses, diseases, or injuries incurred by the subject of this form. I give permission for my son/daughter to attend.

Payment: (insert 0 if not paying or donating right now).

Cost is $225 ($50 non-refundable deposit due May 1 to hold your spot)

Donate for Scholarships

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Expiration Date/CVC

Name on Card Card Billing Address

Description

Monday June 30- Saturday July 5

We are excited to host a new service trip this summer and work with Heirloom East Bay, in Castro Valley, Ca. FCC Youth will be helping the church around their farm with gardening, working with animals and various projects as needed.

REQUIRED TEAM MEETING: Sunday, June 8th 11:30am-12pm

Heirloom Farm Service Trip

Description

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