High School Movie Night

Name of Student

Student's Phone

Student's Date of Birth

Address

Parent/Guardian's Name

Parent/Guardian's 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?

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

July 16, 7-10pm

Join us for a movie at Cassidy's House. Bring a snack to share.

High School Movie Night

Description

Please Fix the Following