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Trip and Event Authorization and Release Form 

We (I), the undersigned parent(s) of Minor listed below hereby authorize and approve the said student’s travel for all the trips with Galilee Christian Church he or she participates during this year.

The undersigned hereby releases Galilee Christian Church, it agents, employees, members, sponsors, ministers and vehicle drivers from liability, claims, demands, actions and causes of action whatsoever arising out of, or related to, any loss, damage or injury which may be sustained by the above referenced said student or the undersigned parent or guardian while the said student is traveling to or from, or participating in, any church activities or trips.

In the event of an accident or injury to the above named student, when time is of the essence, I hereby authorize the event sponsor(s) to seek and authorize medical treatment by the best available medical personnel.

Today's date: July 26, 2024

First Student's Name

First Name*

Last Name*
First Student's Age Acknowledgment*
First Student's Date of Birth*
I certify that I am 14 years of age or older
First Student's Information

Please list any allergic reactions or medications your child has:
First Student's Signature*
Second Student's Name

First Name*

Last Name*
Second Student's Date of Birth*
Second Student's Information

Please list any allergic reactions or medications your child has:
Third Student's Name

First Name*

Last Name*
Third Student's Date of Birth*
Third Student's Information

Please list any allergic reactions or medications your child has:
Fourth Student's Name

First Name*

Last Name*
Fourth Student's Date of Birth*
Fourth Student's Information

Please list any allergic reactions or medications your child has:
Fifth Student's Name

First Name*

Last Name*
Fifth Student's Date of Birth*
Fifth Student's Information

Please list any allergic reactions or medications your child has:
Sixth Student's Name

First Name*

Last Name*
Sixth Student's Date of Birth*
Sixth Student's Information

Please list any allergic reactions or medications your child has:
Seventh Student's Name

First Name*

Last Name*
Seventh Student's Date of Birth*
Seventh Student's Information

Please list any allergic reactions or medications your child has:
Eighth Student's Name

First Name*

Last Name*
Eighth Student's Date of Birth*
Eighth Student's Information

Please list any allergic reactions or medications your child has:
Ninth Student's Name

First Name*

Last Name*
Ninth Student's Date of Birth*
Ninth Student's Information

Please list any allergic reactions or medications your child has:
Tenth Student's Name

First Name*

Last Name*
Tenth Student's Date of Birth*
Tenth Student's Information

Please list any allergic reactions or medications your child has:
Insurance

Insurance Carrier*

Insurance Policy Number*
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*
Parent or Guardian's Email Address

Email*

Confirm Email*
Student's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent(s) or Court-Appointed Legal Guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*
Parent or Guardian's Age Acknowledgment*
Parent or Guardian's Date of Birth*
I certify that I am 14 years of age or older
Parent or Guardian's Information

Please list any allergic reactions or medications your child has:
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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