FBC Annual Student Ministry Activity Form

This form is to be filled out by parents annually and is required prior to registration for any activity involving overnight stays or offsite transportation. Please provide the necessary information and have both student and parent sign it. Please note that while this form must be filled out annually, each specific event requiring parental permission will have an abbreviated form to be filled out in the event registration.

Student Name

Student First Name

Student Last Name

Parent / Guardian Agreement

I understand Felida Youth Ministry's behavioral standards and have discussed them with my student. I am available to pick my student up should the need arise.

I understand that transportation for Felida Youth Ministries is provided with the church van and/or private car unless otherwise noted in the event's general information.

I understand that photographs and videos of my child may be taken and used in various media presentations.

I understand that supervision is provided by volunteers from Felida Bible Church who will exert every reasonable precaution to ensure the safety of the participants.

I understand that all activities involving youth possess a potential for injury, death and dismemberment and therefore will not in the event of an injury to my child, hold Felida Bible Church or any person working as a staff member or its volunteers responsible. Should the need or emergency arise I grant Felida Youth Ministry's adult supervisor permission to secure any medical aid or treatment, such as doctor or hospital care. I leave this decision up to the judgment of the adult supervisor.

Parent / Guardian First Name

Parent / Guardian Last Name

Parent / Guardian Email

Parent / Guardian Phone Number

Parent / Guardian Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Parent / Guardian Signature

Date Signed

Student Agreement

I, the participating student, agree to cooperate with the youth staff and to comply with Felida Youth Ministry's behavioral standards.

I agree to conduct myself in a manner conducive to learning, worship, and biblical ethics.

I understand that inappropriate dress, appearance, or behavior which disrupts the purpose of Felida Youth Ministry is not permitted.

Furthermore, I understand that should I be unwilling to cooperate with the Youth Staff or comply with Felida Youth Ministry behavioral standards, I will be sent home at my parent's/guardian's expense.

Student First Name

Student Last Name

Student Birthdate

Student Grade

Student Gender

Student Email

Student Phone Number

Student Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Student Signature

Date Signed

Medical And Emergency Contact Information

Medical Insurance Provider

Medical Insurance Policy Number

Student Allergies

In case of emergency, who should we contact if the parent / Guardian is unavailable?

Emergency Contact First Name

Emergency Contact Last Name

Emergency Contact Phone Number

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