Parent Approval *

Hiking

Swimming

Student's Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Sex *

Male

Female

Parent's Name *

First Name

Last Name

Parent's Phone Number *

(###)

###

####

Parent and Student Release Statement *

As parent/legal guardian of the student this form concerns, I have reviewed the information about the youth ministry activity/event and give my permission for the subject of this release to be involved in the event. I/We consent to the use of any video images, photographs, audio recordings, or any other visual or audio reproduction that may be taken of the subject of this release during the activity/event to be used, distributed, or shown as Bethel Grove Bible Church sees fit. I/We understand all reasonable safety precautions will be taken at all times by Bethel Grove Bible Church and its agents during the events and activities. I/We understand the possibility of unforeseen hazards and know the inherent possibility of risk. I/We agree not to hold Bethel Grove Bible Church, its leaders, employees, and volunteer staff liable for damages, losses, diseases, or injuries incurred by the subject of this form. I/We understand all reasonable safety precautions will be taken, with regards to COVID-19, by Bethel Grove Bible Church and its agents during the event and activities. I/We understand the possibility of unforeseen hazards and know the inherent possibility of risk. I/We agree not to hold Bethel Grove Bible Church, its leaders, employees, and volunteer staff liable for damages, losses, diseases, or injuries incurred by the subject of this form.

By checking this box I/We agree to the Parent and Student Release Statement

Drivers *

Please check one:

We (parents) will be available to drive for this event.

We (parents) will not be available to drive for this event.

Payment *

Please make all checks payable to Bethel Grove Bible Church with HS DAKs Trip on the memo line.

Payment will be submitted in person (cash or check)

Payment will be submitted via mail

Venmo (will send link once it is working)