Reality Student Ministries

What: Water Ski Party

Where: Colby Granstroms House
Cost: $5
Transportation: Church Vans
When: August 26th, 2009 from 4-9pm

Personal Information
Name:_______________________________ Age:_____ Sex: M F (circle one)
Address:_________________________________City:__________________________
State:_____ Zip:_________________ Phone:__________________________________
Date of Birth:________________

Parent’s Information
Name:_______________________________Phone:_____________________________
Address:__________________________________ City:_____________ Zip:________

Health Information
Are you in excellent health?________ If no, why?_______________________________
_______________________________________________________________________
Do you take any medication?________ If yes, please list:_________________________
_______________________________________________________________________

I, _________________________, give permission for ____________________ to attend

The Water Ski Party on August 26th, 2009 with Reality Student Ministries, of Lake Stevens
Assembly of God. I also give permission for any medical attention in case of accident,
with the understanding that reasonable effort will be made to contact me immediately. I
release Lake Stevens Assembly of God/Reality Student Ministries and agree to hold it
harmless from any liability incurred from the above named minor in connection with the
above described activity.

___________________________ _________ ________________ _________________

parent/guardian signature date cell phone emergency phone

**IMPORTANT NOTE: Cost of The Water Ski Party is $5. Make checks payable to
Lake Stevens AG and write “Water Ski Party” and attending student’s name in the “for”
column. Thanks! Questions? Contact Pastor Jeff at: Phone: 425.334.3700 E-mail:
Jeffandtiffgraham@yahoo.com