STUDENT INFORMATION
Name *
Name
Birth Date *
Birth Date
EMERGENCY CONTACT INFORMATION
Name of Parent/Guardian *
Name of Parent/Guardian
MEDICAL INSURANCE
Parental Release *
I hereby authorize my child to attend Ziplining 2016 and state to the best of my knowledge my child is healthy and fit for an active program. I acknowledge that there may be the inherent possibility of risk and therefore release all parties involved from any liability for loss, damage, injury, disease or death involving my child, resulting from any activities during this event taking place on Oct 22nd 2016. Further I authorize the staff and/or volunteer adult leaders for this trip to consent for any medical care, dental care or both in the event that it is needed, in the event that I cannot be reached. Lifehouse Youth Group or The Lifehouse Church are not liable for lost or stolen property.