NNC: NazTeenz Group Outing Permission Slip

In order to participate in an activity at Newton Nazarene Church, one (1) Activity Participation Agreement must be filled out for each Participant.

Your name *

Email address *

Event Name *

Date(s) of Activity *

Participant Information

(To be completed by Participant or authorized Parent/Guardian if under 18 years old)

Name of Participant *

Birthdate *

Is the Participant under 18 years old? *

Phone number *

Emergency Contact

Phone number

Emergency Contact

Phone number

Participation Agreement

I, being 18 years of age or older, do for myself (and for and on behalf of my child if said child is not 18 years of age or older) hereby release, forever discharge and agree to hold harmless Newton First Church of the Nazarene and the directors thereof from any and all liability, claims or demands for personal injury, sickness or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by the undersigned and the child-participant that occur while said child is participating in an activity of the church. I [and on behalf of our (my) child-participant if under the age of 18 years] hereby assume all risk of personal injury, sickness, death, damage and expense as a result of participation in recreation involved therein. I further understand that, in the event my child requires medical treatment while engaged in church activities, reasonable efforts will be made to contact me; however, if I cannot be reached, I hereby consent and give permission to the ministry’s sponsor or any adult counselor acting on belief of the Church of the Nazarene, as agent for me, to consent to any medical treatment, hospital care and treatment advised and supervised by a physician or surgeon licensed to practice under the laws of the state.

Digital Signature of Participant *

Please type your full name.

Date *

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