Outing Permission & Medical Release Form - Mosaic Christian Fellowship

Full Name of the Parent Filling Out This Form (you): *

First

Last

Phone Number: *

Full Name of My Child: *

First

Last

Do you have more than one child who will be attending? *

This Outing/Event is Coordinated By: *

Name of the Outing: *

Date and Time of the Outing: *

Date

Time

I authorize my child/children (named above) to attend the this outing/event. By signing my name in this section I give full consent and permission: *

Type Full Name to Sign

MEDICAL RELEASE FORM “I consent and give the Texas Conference of Seventh-day Adventist Youth Ministry and Mosaic C. Fellowship Seventh day Adventist Youth Ministry permission to select a medical treatment facility, physician, and all necessary emergency medical care required in case of an accident or emergency illness for my minor child.” Note: Every effort will made to contact parent or guardian in case of an emergency. (Please sign full name and date below) *

Type Full Name to Sign

Today's Date: *

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