Consent Form

The consent form is here! Please copy and paste this, print it out, fill it out and turn it in to your youth pastor, trip leader or send it to Ryan Goode.

Remember! Your form must be Notarized!



Indianapolis District NYI


PARENT OR GUARDIAN OF A MINOR
CONSENT AND HOLD HARMLESS FORM


Name of activity: Mission to the Gulf Mission Trip Date: July 7-13, 2008
Child’s Name:_____________________________________________________
Date of birth:________________________________ Age: ______ Sex: ______
Address: ________________________________________________________
Home Phone number: ______________ Cell Phone Number: _____________
Emergency # you can be reached day of event: _____________

I, _______________________ (printed name of parent/guardian) being the parent or legal guardian of ____________________________ (printed name of minor) have been informed of the above activity sponsored by the Indianapolis District Church of the Nazarene NYI and hereby give my consent for my minor child to participate in this activity.

I understand that all reasonable safety precautions will be taken by the leaders of this activity, and that the possibility of an unforeseen hazard does exist. I further agree not to hold the Indianapolis District Church of the Nazarene its leaders, employees, and volunteer staff liable for damages, losses, diseases, or injuries incurred by the minor listed on this form.

I also understand that my minor child is to be excluded from the following activities:



Signature of parent/Guardian _________________________Date____________
Notary Seal:



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