Request edit access
Cash and check payments can be made @the church office Mon-Thur or Sunday @the church.
Please mark the grade they are going into.
Parent or Guardian Name:
Parent or Guardian Number:
Current Medicine and instructions of use:
By checking below I "agree" to each of the following items
First aid release: In the event that my Child requires basic over-the-counter medication, such as aspirin, ibuprofen, tums, cough drops etc.. I authorize Sager Creek to administer such medications to my child.
Medical Release: In the event of a medical emergency when I cannot be contacted, I give my permission for treatment deemed necessary in consultation between attending emergency physician and the Event Leader. I also release Sager Creek Community Church of liability in the case of accidents or injuries to the minor listed above while traveling to and from, and while participating in the event(s).
By checking below I "agree" to each of the following items:
I, the parent or legal guardian of the child mentioned above, am informed of the Youth Summer Camp offered by Sager Creek Community Church, on the days of June 21-24, 2018. As the parent or legal guardian of my child, I hereby consent for my child to attend and participate in all activities provided.
I hereby authorize Sager Creek Community Church, its Event Leaders, employees and volunteers who are 18 years of age or older, and supervise the activities during 2018 to consent to emergency medical care, dental care, or both, for my child.
I understand that payment of $125 dollars for the event has to be made to Sager Creek Community Church on or before June 21, 2018.
Electronic Signature of Parent or Guardian:
Please type your First and Last Name
Never submit passwords through Google Forms.
This form was created inside of Sager Creek Community Church.
Terms of Service