Neary Lagoon Fieldtrip

Participant's Name

Participant's Date of Birth

Parent/Guardian's Name :

Parent/Guardian Phone:

Parent/Guardian Email:

This address will receive a confirmation email

Secondary Emergency Contact and Phone Number

Health Insurance Carrier and Policy Number

Any allergies/Disabilities?

Please Read and Sign

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.

Description

Tuesday, June 27, 10am-1pm

Those kids entering 3-6th grade are invited to join us for a day out with birding, picnic, and painting led by our very own expert Micah Hughes!

Drop Off at FCC parking lot: 10am
Pick Up at FCC parking lot: 1pm

Please wear good walking shoes and brinh your own sack lunch for our picnic and binoculars if you have them.
We will bring extra! :)

Neary Lagoon Fieldtrip

Description

Please Fix the Following