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KIDZ
DAY Summer Session 2003 - Permission Form #1
Each
field trip will depart from the River Run Ministry Center
at the time stated in the above chart . Please have
your child present 15 minutes
before the departure time. The trip will
return to the River Run Ministry Center at the times
stated. Please make arrangements for your child to be
picked up at the appropriate time for each trip.
Our church van and chaperone’s private vehicles
will provide transportation for each trip. There will
be only 4 children assigned to each chaperone. With
every chaperone that signs up 4 spots will open up for
children. The trips are first come first serve. It is
best to plan ahead and turn in the money and permission
forms for all trips your children will attend as soon
as possible.
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Date
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Place
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Name
of Child Attending
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Name
of
Chaperone
Attending
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June
12
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Gatorland
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|
 |
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June
19
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Orange
County
Regional History
Center
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June
26
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Plaster
House
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|
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July
10
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Riverside
Park
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|
|
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July
17
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Orlando
Science Center
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July
24
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Sea
World
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I
give my child _______________ permission to attend the
above KIDZ DAY events sponsored by River Run Christian
Church’s Children’s Ministry.
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Guardian Signature:______________________ Date:___________
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Emergency
Contact:
Name:_______________________ Phone #: __________
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Liability/Medical
Release
Release of All Claims
In consideration for being accepted by River Run Christian
Church for participation in the KIDZ DAYZ field trip
program, we being the parent(s) or legal
guardian(s) of ___________________, do release and agree
to
hold harmless River Run Christian Church, the director,
its staff, agents, volunteers, and employees thereof
from any and all liability, claims, or demands for personal
injury, as well as damage and expenses, of any nature
that may be incurred by the parent/guardian and child-participant
that occur while the child is participating in the above
described trip or activity, even if said claims arise
on account of the negligence of those persons released
herein.
We, on the behalf of our child-participant, assume all
risk of personal injury, damage, and expense as the
result of participation in recreational activities involved.
Authorization and permission are given to said church
to furnish any necessary transportation, food, and lodging
for our child-participant.
We, as parents/legal guardians of the child-participant,
give our permission for him/her to participate fully
in the trip/activity. We give our permission to take
said participant to a doctor or hospital and authorized
medical treatment, including but not limited to emergency
surgery or medical treatment, and assume the responsibility
of all medical bills, if any. We understand that we
will be contacted if at all possible and that our family
physician will be contacted if possible, but in the
event that he/she cannot be reached, the minister/trip
leader may choose a reputable physician.
Should it be necessary for the participant to return
home due to medical reasons, disciplinary action, or
other wise, we assume all transportation costs.
__________________________
Name of Child
Father’s Signature:_______________________ Date:__________
Mother’s Signature:_______________________ Date:__________
(Both Parents must sign, unless parents
are separated or divorced in which case the custodial
parent must sign.)
Father’s Daytime Phone:__________________
Mother’s Daytime Phone:__________________
Medical Insurance? Yes __ No __
Insurance Company: ___________________________
Policy Number:_____________________
Physician’s Name:___________________________
Physician’s
Phone:______________________
___________________________________________________
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