New Testament Baptist Church
New Testament Baptist Church Proclamation! Youth Events
January 2016 - January 2017
Youth Name ________________________________ Age______ Birth Date ________________ Address_______________________________________________________________________ Parent/s or Legal Guardian/s _____________________________________________________ Emergency Contact: Home________________________ Cell ___________________________ Insurance Carrier __________________________ Policy #______________________________ Any known allergies we need to be aware of?________________________________________ Physical limitations we need to be aware of?_________________________________________ I, _____________________________ hereby give my permission for _____________________ To participate in Proclamation! Youth Events. I understand that, although due diligence will be given to keep my child named above from being injured, unforeseen accidents or conditions can happen. If my child needs immediate emergency medical attention, I give the youth Staff of New Testament Baptist Church permission to seek competent, professional, emergency medical attention on my child’s behalf. I understand that every attempt will be made to contact me first if possible, and those attempts will not stop until I am reached.
Name of Parent/legal guardian_________________________________________ Signature_____________________________________ Date_________________ Contact Numbers during the Youth Event: Church line: 449-2354 Scott Corbin's Cell: (315) 744-4601 Barbi Corbin's Cell: (315) 505-6644 Bryan Losier’s Cell: (315) 373-1850 Tricia Losier’s Cell: (315) 256-2030
January 2016 - January 2017
Youth Name ________________________________ Age______ Birth Date ________________ Address_______________________________________________________________________ Parent/s or Legal Guardian/s _____________________________________________________ Emergency Contact: Home________________________ Cell ___________________________ Insurance Carrier __________________________ Policy #______________________________ Any known allergies we need to be aware of?________________________________________ Physical limitations we need to be aware of?_________________________________________ I, _____________________________ hereby give my permission for _____________________ To participate in Proclamation! Youth Events. I understand that, although due diligence will be given to keep my child named above from being injured, unforeseen accidents or conditions can happen. If my child needs immediate emergency medical attention, I give the youth Staff of New Testament Baptist Church permission to seek competent, professional, emergency medical attention on my child’s behalf. I understand that every attempt will be made to contact me first if possible, and those attempts will not stop until I am reached.
Name of Parent/legal guardian_________________________________________ Signature_____________________________________ Date_________________ Contact Numbers during the Youth Event: Church line: 449-2354 Scott Corbin's Cell: (315) 744-4601 Barbi Corbin's Cell: (315) 505-6644 Bryan Losier’s Cell: (315) 373-1850 Tricia Losier’s Cell: (315) 256-2030
