Student's Name *

First Name

Last Name

Parent or Legal Guardian's Name *

First Name

Last Name

Date *

MM

DD

YYYY

To Participate In *

All Activities

Signature of Parent of Legal Guardian: Liability *

In consideration for the above-named student's participation in the above-referenced event/activity, I, for myself and on behalf of the above-named student agree to release the Pandora Missionary Church, its officers, directors, and agents and anyone connected or associated with the church from any liability for injuries to the above-named minor arising out of his/her participation in the above-referenced event/activity, including during their transportation to and from said event/activity.

I Agree

Signature of Parent or Legal Guardian: Media *

I hereby, authorize Pandora Missionary Church (PMC), to publish the photographs taken of me and/or the undersigned minor children and our names, for use in the PMC printed publications, website or social media. I give permission, to PMC to copyright, use and publish the photographs of my child with or without names for any lawful purpose, including illustrations, advertising and web content. I release, all claims against PMC with respect to ownership and publication including any claims of compensation. I confirm that I am the parent or legal guardian of the minor child(ren) and have the authority to authorize to use their photographs and names.

I Agree

Address of Student *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Student's Birth Date *

MM

DD

YYYY

Medical Release *

I agree and consent to having a staff member of the Pandora Missionary Church give permission for my student to receive medical attention in the event of an accident or illness while attending any event. This includes travel to and from the event/activity as well as the event/activity itself. I accept responsibility for any and all financial obligations incurred for such treatment.

I Agree

Do you have Medical Insurance? *

Yes

No

Insured's Date of Birth

MM

DD

YYYY

Emergency Phone Number *

(###)

###

####

Signature of Parent or Legal Guardian: Behavior *

Parents and Students, please read and discuss the following: On all of our events, we have certain expectations regarding behavior which will insure that we all have a great experience. If, during this event, you are unwilling to maintain these expectations, please understand that your parents will be notified. Further, should it be necessary for the participant to return home due to disciplinary action or otherwise, parents will assume all transportations costs. Please agree that you understand this and agree to cooperate.

I Agree