8/8/2019 Ignited Six Flags Trip 2010 Permission Form
1/1
HALLELUJAHJUBILEE
at Six Flags Magic MountainSATURDAY, SEPTEMBER 25th
including free concerts with Pillar,Superchick, and other
bands!
Cost: $25(this doesnt include
food!)PleasemakecheckspayabletoCalvaryWorshipCenter
To reserve your spot, please fill out the form below &return
to an Ignited leader with money ASAP!
FRIENDS ARE WELCOME!
Name _____________________________________
Cell Phone # _________________________________
Emergency Contact Name ________________________
Emergency Contact # ___________________________
Authorization & Medical Release (Mumbo
Jumbo)Astheparentorguardianoftheminornamedabove,Igivepermissionformychildto
participate in the activity stated above.My child has my permission
to betransported to andfrom this activity. I understand that
neither CalvaryWorshipCenteroranyof its agentsareresponsible
foranyinjury sustainedbymy child.Iacceptcomplete responsibility
forany medicalexpenses as a result ofanysuchinjury sustained.I
doherewithauthorizethetreatmentbyaqualifiedandlicensedmedical
doctorof my child in the eventof amedical emergency which,in
theopinion of the attending physician, may endanger his or her
life,
causedisfigurement,physicalimpairment,orunderdiscomfortifdelayed.Thisauthorityisgrantedonlyafterareasonableefforthasbeenmadetoreachme.
Signature Parent/Guardian _______________________
Date ______________________________________
HALLELUJAHJUBILEE
at Six Flags Magic MountainSATURDAY, SEPTEMBER 25th
including free concerts with Pillar,Superchick, and other
bands!
Cost: $25(this doesnt include
food!)PleasemakecheckspayabletoCalvaryWorshipCenter
To reserve your spot, please fill out the form below &return
to an Ignited leader with money ASAP!
FRIENDS ARE WELCOME!
Name _____________________________________
Cell Phone # _________________________________
Emergency Contact Name ________________________
Emergency Contact # ___________________________
Authorization & Medical Release (Mumbo
Jumbo)Astheparentorguardianoftheminornamedabove,Igivepermissionformychildto
participate in the activity stated above.My child has my permission
to betransported to andfrom this activity. I understand that
neither CalvaryWorshipCenteroranyof its agentsareresponsible
foranyinjury sustainedbymy child.Iacceptcomplete responsibility
forany medicalexpenses as a result ofanysuchinjury sustained.I
doherewithauthorizethetreatmentbyaqualifiedandlicensedmedical
doctorof my child in the eventof amedical emergency which,in
theopinion of the attending physician, may endanger his or her
life,
causedisfigurement,physicalimpairment,orunderdiscomfortifdelayed.Thisauthorityisgrantedonlyafterareasonableefforthasbeenmadetoreachme.
Signature Parent/Guardian _______________________
Date ______________________________________
