Parent/Guardian Permission & Medical Release Form

Date of event: August 7th & 8th

Event & destination: 24 Hour Training Course
Activities include but are not limited traveling in the passenger van, & ultimate frisbee
Please print legibly.

Student Name: ___________________________________Phone #: ______________________

Address: _____________________________City:_______________ State: _____ Zip: _________
Sex: _____ Age: ____ Grade: ____
Father/Guardian/Custodian Name: ________________________________________________
Home #: ___________________________ Work #: ____________ Cell #: __________________ training course
Mother/Guardian/Custodian Name: ______________________________________________
Home #: ____________ Work #: ______________________ Cell #: _______________________

Insurance and Medical Information:

Preparation
Insurance Company: ______________________________ Phone #: _____________________
Policy #: ________________________________________ Group #:
_______________________________________
Medications being taken: We will spend 24 hours helping training you for the upcoming
__________________________________________________________________
Food or Medication Allergies: school year. With lessons talking about how to be make a
____________________________________________________________________________
difference at your school. With games helping you get back
ALL MEDICATIONS MUST BE CLEARLY LABELED WITH STUDENT’S NAME &
INSTRUCTIONS, AND TURNED IN TO THE YOUTH PASTOR.
into gear for a great school year.
I have read this form and I give permission for my son/daughter to participate in the activities
described above. My child has my permission to engage in all activities except as noted by me. The
information on this registration form is correct as far as I know. In the event that I cannot be reached
in an emergency, I hereby give permission for the physician selected by the Youth Pastor of Vision
Baptist Church or his designate to hospitalize, secure proper treatment for, and to order injection,
anesthesia, or surgery for my child named on this registration. In consideration of Vision Baptist
Church , I, for myself or for the minor child named above, forever waive, release and discharge
Vision Baptist Church and its staff and volunteers, from any/all injuries, claims, disputes, liabilities
or actions resulting from Vision Baptist Church providing services for me and for my benefit
regardless of location. I attest and verify that I have full knowledge of the risks and dangers

Friday, August 7th

involved; that I assume such risks and that I will assume and pay my own medical and emergency
expenses in the event of an accident, illness or other incapacity regardless of whether I have

Starts at the church at 1:00 pm

authorized such expenses.
I HAVE READ THIS WAIVER AND RELEASE CAREFULLY AND UNDERSTAND IT.
Eat lunch before you come.
_______________________________________________ _____________________________
Signature of Parent/Guardian if participant is under 18 yrs. of age

Relationship Saturday, August 8th

Date Ends at the church at 1:00 pm TR A IN IN G C OU R S E
PLEASE COMPLETE AND RETURN THIS FORM TO VBC’s CHURCH OFFICE ASAP
1235 Old Alpharetta Road Alpharetta, GA 30005
770.456.5881
For Office Use Only
Check #: _____ Amount: ______ Date: ______ Initials: _____
Back to School Training Course

Going back to school can bring some new

challenges. We are going to help you get
equipped spiritually, mentally, and physically
for those challenges.
Training in Ultimate Frisbee
You will receive training in the art of ultimate
frisbee. An ancient sport that will help keep
you in physical shape for the school year.
COURSES:
WHY PIZZA IS GOOD FOOD BEFORE
RULES, REGULATIONS, & TECHNIQUES

24 hours of training Training on how to find new friends

Every school year it seems that you find new

for $24 dollars

discounts for families with 2 or more students
friends> we are going to give training in what
to look for in a new friend.
COURSES:
WHAT TO WATCH OUT FOR
PROPER USE OF SOCIAL MEDIA

who can attend Training in how to be a balanced

everyone going into middle school or
high school
We will have separate sessions for each
Christian student.
We are going to show you how to prioritize
your time to leave the time needed for God,
your family, and your studies.

contact info
COURSES:
Students of Vision
HOW TO MAKE A SCHEDULE & KEEP IT
office: 770.456.5881 HOW TO PRIORITIZE YOUR TIME
Trent Cornwell / Student Pastor
cell: 770.853.8148