PARENT INFORMATION and RELEASE FORM

Please complete and submit this form that gives your permission for your child to participate in events with The Gateway Church, permission to transport, and emergency information should it be necessary.

Student's Name
Gender at birth
Current Address

Parent(s) / Legal Guardian(s) Information

Please include all parents/guardians for student - it is recommended there be at least two people who can be Emergency Contacts in case the first parent/guardian cannot be contacted - up to 4 parents/guardians can be included in this form.
Parent/Guardian Name
Please check the box if this Parent/Guardian is also an Emergency Contact.
Mother, Grandfather, Nanny, etc.
Is the address of this Parent/Guardian the same as the student?
Address (if different than student's address)

Consent & Release Statement

Release Statement

As parent/legal guardian of this student, I have reviewed the information about the ministry activity/event and give my permission for the student of this release to be involved in the overall activities and in specific activities mentioned in the field below. This permission includes the release to transport the student to and from the event. I/We understand that all reasonable precautions will be taken at all times by The Gateway Church and its agents during the event and activities. I/We understand the possibility of unforseen hazards and know the inherent possibility of risk. I/We agree not to hold The Gateway Church, its leaders, employees, agents, and volunteer staff liable for damages, losses, diseases, or injuries incurred by the student of this release form during this activity/event.

Emergency Medical/Dental Care

I hereby authorize The Gateway Church's leader/agent(s) to consent to emergency medical care, dental care, or both, for my child in the unlikely event that I or other specified adult above are unable to be reached. I further authorize The Gateway Church's leader/agent(s) to receive physical custody of my child upon completion of any treatment, and I specifically instruct any treating health facility to surrender physical custody of my child to The Gateway Church's leader/agent(s).

Agreement to Emergency Medical/Dental Care:

Event Participation Agreement

I Agree That My Child May:
Checking the "Take part ONLY in the event detailed below" box will open a section where you can fill in the specific event you are giving permission for.

Insurance Information

Name of Parent/Legal Guardian Completing this Form
Clear Signature