Parent Consent Form
I, the parent or legal guardian of the student listed below, certify that he/she
has my full approval to attend and participate in
Activities and Programs for 2024 at
First Christian Church of Washington, MO.
The individual identified on this form understands and acknowledges by signing below that all students are expected to abide by the Program rules and be directly responsible to the First Christian Church Staff. Said Staff assumes responsibility for discipline at activities and programs and, if necessary, may, because of misconduct or disobedience, require a student to leave. In such instance, I will assume responsibility for returning the student home. Further, I do release and hereby agree to hold First Christian Church, its employees and agents, blameless from any and every claim arising, or which may be asserted by me or by any member of my family by reason of participating in any activities or programs.
Further, I do authorize the minister, sponsor, or staff member, in the event I cannot be reached by phone, to give consent to any X-ray examination, anesthetic, medical, surgical or dental diagnosis or treatment, and hospital care, to be rendered to the minor under the general or special supervision and on the advice of any physician or dentist licensed under the provisions of the Medical Practice Act on the medical staff of a licensed hospital, whether such diagnosis or treatment is rendered at the office of said physician or at said hospital. It is under-stood that I will assume any financial responsibility for any expense that may be incurred for said emergency treatment. I do certify that said child is covered by adequate accident insurance. Should it be necessary for my child to return home due to medical reasons or otherwise, the undersigned shall assume all transportation costs.
The undersigned does also hereby give permission for my child to ride in any vehicle designated by the adult in whose care the minor has been entrusted while attending and participating in activities sponsored by First Christian Church of Washington. I have read and agree to the information given in this entire form.
has my full approval to attend and participate in
Activities and Programs for 2024 at
First Christian Church of Washington, MO.
The individual identified on this form understands and acknowledges by signing below that all students are expected to abide by the Program rules and be directly responsible to the First Christian Church Staff. Said Staff assumes responsibility for discipline at activities and programs and, if necessary, may, because of misconduct or disobedience, require a student to leave. In such instance, I will assume responsibility for returning the student home. Further, I do release and hereby agree to hold First Christian Church, its employees and agents, blameless from any and every claim arising, or which may be asserted by me or by any member of my family by reason of participating in any activities or programs.
Further, I do authorize the minister, sponsor, or staff member, in the event I cannot be reached by phone, to give consent to any X-ray examination, anesthetic, medical, surgical or dental diagnosis or treatment, and hospital care, to be rendered to the minor under the general or special supervision and on the advice of any physician or dentist licensed under the provisions of the Medical Practice Act on the medical staff of a licensed hospital, whether such diagnosis or treatment is rendered at the office of said physician or at said hospital. It is under-stood that I will assume any financial responsibility for any expense that may be incurred for said emergency treatment. I do certify that said child is covered by adequate accident insurance. Should it be necessary for my child to return home due to medical reasons or otherwise, the undersigned shall assume all transportation costs.
The undersigned does also hereby give permission for my child to ride in any vehicle designated by the adult in whose care the minor has been entrusted while attending and participating in activities sponsored by First Christian Church of Washington. I have read and agree to the information given in this entire form.